Virtual Death Cafés fail to prevent burnout in ICU clinicians
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Key takeaways:
- The proportion of clinicians with burnout at 6 months did not significantly differ between those in vs. not in the Death Café group.
- Despite this, many Death Café participants said the sessions were valuable.
During the COVID-19 pandemic, ICU clinicians who participated in virtual group discussions about death did not have significantly lower burnout at 6 months, according to results published in Annals of the American Thoracic Society.
However, this trial evaluating these discussions, known as Death Cafés, struggled with enrollment and attrition, according to researchers.
“Burnout, anxiety and depression are highly prevalent among ICU clinicians,” Joshua L. Denson, MD, MSCR, assistant professor of medicine and director of medical intensive care at Tulane University School of Medicine, told Healio. “The first step is recognition of this fact, which we as a community are starting to do. Only then can we move forward with trials to identify ways to mitigate burnout and create ICU work environments that energize and uplift its employees rather than leaving them in a pile of rubble.”
In the multicenter, randomized controlled STOPTHEBURN trial, Denson and colleagues evaluated 251 ICU clinicians (mean age, 31 years; 63% women; 72% white) from July 2020 to December 2022 to determine the impact regular virtual Death Café participation has on burnout via the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) after 6 months.
Due to COVID-19, the Death Cafés had to be virtual rather than in-person and target enrollment of ICU clinicians was not met, Denson said.
“The study was approved right as the COVID-19 pandemic began in early 2020, so we had to pivot to a virtual format for our Death Cafe intervention while at the same time enrolling ICU employees who were experiencing severe fatigue, burnout and emotional trauma from COVID-19,” Denson told Healio.
Clinicians assigned to the Death Café group were instructed to participate in four psychotherapist-facilitated virtual sessions, but a majority attended less than four vs. four (n = 92 vs. n = 34).
Using the clinicians with a completed baseline survey (n = 246), the Death Café group included 123 clinicians (mean age, 30.7 years; 62% women; 69% white) and the control group included 123 clinicians (mean age, 31.3 years; 65% women; 75% white),
A large proportion of clinicians reported being nurses (37%), followed by residents (27%), interns (25%) and other ICU staff (11%).
Both the Death Café group and the control group had similar mean years of experience (3.6 years vs. 4.2 years) and hours worked per week (56.8 hours vs. 55.9 hours).
Burnout, Death Café feedback
At baseline, 19% of clinicians had burnout.
Six-month follow-up data were only available for 136 clinicians (Death Café, n = 45; controls, n = 91) and showed that the proportion of clinicians with burnout did not significantly differ between those in vs. not in the Death Café group (18% vs. 25%).
“I was disappointed that attendance was difficult to maintain and therefore contributed to our lack of a significant difference between groups,” Denson told Healio. “However, we ran this clinical trial during the onset and peak of COVID-19, so I guess this finding is not entirely unexpected given how much work our participants were doing and how much emotional energy they were already expending at work to then go and participate in our trial. It’s entirely understandable.”
Similar to burnout, anxiety (measured via the General Anxiety Disorder-7 questionnaire) and depression (measured via the Patient Health Questionnaire-8) did not significantly differ between the Death Café group and the control group.
Despite the lack of a significant difference in burnout, anxiety and depression between the two groups, researchers found that 56 of 61 (92%) Death Café participants who gave feedback said the sessions were a valuable experience.
Additionally, five participant-reported benefits of Death Cafés arose: “nonjudgemental environment, sense of community, ability to share emotions, space to process experiences and diverse attendee perspectives.”
“I was surprised by how many positive feedback responses we received regarding how much participants enjoyed the intervention,” Denson said. “I occasionally still have clinicians that speak to me about their Death Café sessions and how much they enjoyed them. Although I have also enjoyed the Death Cafés sessions that I had been to previously, I did not expect our participants to enjoy them as much as they did.”
Limitations, future studies
Researchers pointed out two specific limitations of the trial: inability to achieve target enrollment and an attrition rate of 46%.
“While the virtual format may have been more convenient to attend due to its flexibility, the intervention may have been less impactful due to Zoom fatigue and the less social nature of a virtual session as opposed to an in-person Death Café session,” Denson told Healio.
“Since many of the participants were so busy during COVID-19, time allotted to participate in the trial suffered as a result,” he added.
When asked about future studies, Denson said the work environment should be changed.
“Although I think Death Café sessions are beneficial, if the work environment is not conducive to allow its employees the time and energy to seek help, future studies will similarly struggle with enrollment and attrition,” Denson told Healio.