A mixed method integration of clinician distress typologies in those caring for seriously ill patients within the hospital setting.

Abstract

e21000 Background: Hospital clinicians in the US care for almost 34 million patients each year; 40% of whom are seriously ill with one or more co-morbidities. General medicine hospital clinicians—which includes physicians (at all training levels), nurse practitioners, and physician assistants—try to provide expert care for these patients with serious illness while also attending to family needs, interdisciplinary and interpersonal relationships, and the clinician’s own well-being. Clinicians, themselves, are increasingly experiencing psychological distress, which ultimately can impact the delivery of patient-centered care. Yet, the sources of clinician psychological distress are often unmeasured and consistently underrecognized. This study aims to elucidate how qualitative themes of the experience of clinician distress are distributed across the levels of clinician distress clusters/typologies previous defined. Methods: A mixed methods (QUAN→qual) explanatory sequential. Qualitative data augments the identification of distress typologies by providing context and a richer understanding of the clinicians’ experience of distress while caring for seriously ill hospitalized patients. Results: In preliminary work, cluster analysis of 142 encounters yielded four unique clusters: low, moderate, variable, and high distress typologies. Hospital clinicians (n = 25) were interviewed and qualitative themes examined the experience of distress by typology. Mixed analysis confirmed typologies with inductive themes and mean distress thermometer score (DT1) as well as clinician emotional experience mean (Gallup) score: (i) low distress typology theme of “equanimity...but not like a robot” (DT1, 0.73; Gallup 0.53); (ii) moderate distress typology theme of “tightrope” (DT1, 2.98; Gallup, 2.05), (iii) variable distress typology “comfortable in the chaos” (DT1, 3.25; Gallup, 2.19), and (iv) high distress typology inductive code of “weight/waiting” (DT1, 5.79; Gallup, 3.55). Perception of support and work climate was inversely related to distress typology. Conclusions: Mixed analysis expanded the depth and breadth of emotions experienced by clinicians caring for hospitalized seriously ill patients. This mixed methods study advances the understanding of clinician psychological distress and has vital implications for healthcare systems developing workplace resources for support.