COVID-19 has caused an unprecedented healthcare crisis, which has taken a toll on frontline clinicians (FC) [1,2], The MassGeneral Brigham (MGB) hospital system launched an FC resiliency group program and assessed its feasibility, acceptability, and efficacy. Upon IRB approval, English-speaking FCs were recruited (3/23/20–6/02/20) for 17 groups, and completed optional pre and post-treatment surveys. The treatment, previously assessed in caregivers and clinicians, was grounded in relaxation response elicitation, mindfulness, cognitive behavioral therapy, and positive psychology [3,4] and adapted for FCs (health and job uncertainty, clinical role transitions, isolation, and financial and family challenges). Program delivery was modified to eight 1-h biweekly sessions via a HIPAA compliant synchronous videoconferencing platform. Groups were co-facilitated by MGB staff trained in the Stress Management and Resiliency Training-Relaxation Response Program (SMART-3RP) delivery, offered at flexible times, and organized according to FC specialty. Group facilitators attended biweekly clinical supervision, documented attendance, and completed treatment fidelity checklists. No serious adverse events were reported.
Demographics and work characteristics, feasibility (attendance at 6 out of the 8 sessions) and acceptability (program met needs, helpfulness) were assessed. Primary outcomes were assessed by 1–2 items of validated scales: stress reactivity [5], perceived stress coping (0–10 analog), distress [6], and resiliency [7]; and secondary outcomes: loneliness/isolation [8], self-compassion [9], and mindfulness [10]. Descriptive statistics, paired sample t-tests, and Cohen's D were calculated (Stata version 16). Content analyses were conducted (NVivo 12) by 2 independent coders (kappa = 0.92).
147 FCs registered, and 102 (69%) completed a baseline assessment. Participants were 92.1% female, 83.3% White, non-Hispanic, 8.8% Asian, 3.9% Black, 9.8% Hispanic and 2% Other. A variety of clinical specialties were represented with the largest groups: Social Workers/Chaplains/Psychologists (24.5%), Respiratory/Physical/Speech Therapists (18.6%), nurses (17.7%), nurse practitioners and physician assistants (15.7%), and physicians (12.8%). 34.3% of participants reported an increase in work hours in the past month, 81.4% reported a change in work setting, and 49.0% reported a change in clinical role.
One hundred FCs attended at least one session, and 75% of participants completed both a baseline and end of treatment assessment. Participants completed a mean of 6 sessions; 64% completed >6 sessions. 96% of participants agreed that the program met their needs, and 99% agreed that the program was helpful. Participants' open ended responses revealed that the program structure and sharing with others facing similar workplace-challenges were the most helpful aspects of the group. Positive reappraisal and enhancing social support and connectedness were the skills reported as the most helpful. All outcomes significantly improved (ps < 0.01) (Table 1 ) with medium to large effects for all primary outcomes.
Table 1.
Pre/post treatment outcomes (n = 75).
| Pre M (SD) | Post M (SD) | p-value | Cohen's D | |
|---|---|---|---|---|
| Primary Outcomes (Score Range) | ||||
| Stress Coping (analog; 0–10) | 6.5 (1.5) | 7.4 (1.1) | <0.01 | 0.66 |
| Stress Coping Personal Strengths (MOCS-A; 1–5) | ||||
| Coping Response | 3.3 (0.8) | 4.0 (0.7) | <0.01 | 0.80 |
| Emotionally Balanced Thoughts | 3.5 (0.7) | 3.9 (0.7) | <0.01 | 0.50 |
| Resiliency (CES; 0–10) | 6.3 (1.4) | 7.1 (1.5) | <0.01 | 0.56 |
| Emotional Distress (PHQ-4; 0–12) | 3.9 (2.7) | 2.3 (1.9) | <0.01 | 0.64 |
| Secondary Outcomes | ||||
| Loneliness/Isolation (UCLA; 2–8) | 3.1 (1.1) | 2.7 (0.9) | <0.01 | 0.44 |
| Mindfulness (CAMS-R; 2–8) | 5.5 (1.2) | 6.1 (1.1) | <0.01 | 0.55 |
| Self-Compassion (SCS; 1–5) | 3.7 (0.9) | 3.3 (1.0) | <0.01 | 0.35 |
An FC adapted resiliency group program was successfully implemented, across a large hospital system, and decreased COVID-19-associated distress and improved resiliency. Providers were engaged during a public health crisis. Limitations included self-reported outcomes and limited gender diversity. Preserving FC resiliency is of upmost importance during the pandemic and can be achieved through a targeted, accessible group-based treatment.
Funding support
None.
We would like to express our gratitude for our team who volunteered their time, at the onset of the pandemic, to assist frontline clinicians.
Acknowledgements
We would like to thank all the clinicians and MGH Psychiatry leadership for volunteering their time and support at the onset of the pandemic to support the needs of frontline clinicians. We would like to thank the MGH Benson-Henry Institute for Mind Body Medicine, Home Base, and the Mongan Institute for provision of support for this study.
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