Table 2 Included studies

Gardiner et al. [34]

Australia

86 GPs elected to attend a cognitive behavioural management course for which they gained Continued Professional Development

(CPD) points

IG 50-59 years 32.9 %

CG 50-59 years 42.9 %

Setting – metropolitan area Adelaide

15 h over 5 weeks. Cognitive behavioural management.

Aims

1.To improve psychological well-being through stress reduction

2. Have a beneficial effect on coping styles

3. Improve morale through problem-focussed coping

24 GPs attending similar length CPD courses. Reported as being slightly older.

Controlled before and after study

Work-related distress (WRD -7 items Max score 49 = high distress))

Work-related morale

(WRM – 7 items Max score 49 = high morale. Poor = 29)

Quality of working life

(QoWL – Rate statements 1-7. Max score 42. ‘Poor’ = 22)

GHQ-12

(12 considered above threshold for high distress)

Coping with work events (CwWE)

Included to assess role of coping styles in stress outcomes

Outcomes collected at

T1 = Pre-intervention on first night of course

T2 = Post-intervention on last night of course

T3 = 12 weeks after first session

Intervention group (IG)

T1 = 86

T2 = 77

T3 = 62

Control group(CG)

T1 = 24

T2 = 19

Exclusions 0

Withdrawals 0

Lost to follow-up

IG T2 = 9

T3 = 24

CG T2 = 5

WRD- Higher = more distress

IG v CG pre v post-intervention

ANOVA F = 2.99 p = 0.09

T1-T3 in IG F = 9.8 p = 0.000

WRM

Rating morale as ‘poor’

IG v CG pre v post-intervention

ANOVA F =2.1 p = 0.15

T1-T3 in IG F = 12.6 p = 0.000

QoWL

Rating quality as ‘poor’

IG v CG pre v post-intervention

ANOVA F =2.0 p = 0.16

T1-T3 in IG……F = 14.0 p = 0.000

GHQ

IG v CG pre v post-intervention

F = 11.9…p = 0.001

T1 = T3 in IG F = 28.2 p = 0.000

CwWE

IG v CG pre v post intervention

No significant difference

Gardiner et al. [34]

Australia

312 Rural GPs in reference group used to determine actual retention rate;

69 Rural GPs in intervention group who volunteered to attend a work/life balance retreat advertised by Rural Doctors’ Workforce Agency (RDWA)

205 Rural GP respondents to RDWA survey in control group

Majority were male, 2/3 aged 30-50 years.

9 h Work/life balance retreat.

Format

Group and individual CB coaching.

Pre-retreat – Drs’ issues, subjective stress ratings, validated stress questionnaire.

Post retreat

– letter to self at 4 weeks,

e-mail follow-up and support for 5-6 weeks,

Interview to assess goals at 10 weeks, validated stress questionnaire.

Over 3 years 8 retreats were held.

Baseline data from RDWA survey reported in Gardiner 2005.

205/440 respondents to survey were used as the control group for the intervention.

The entire population of rural GPs (312) was used to calculate actual retention rate at 42 months after the intervention

Controlled before and after study.

Rural Doctor Distress (RDD)

(Customised 10 item scale graded 1-7 where 1 = not at all)

Doctors’ Intention to leave rural practice

(ITL)

(Rated by IG on scale 1-7 where 1 = not at all)

Actual retention rate of rural GPs

(ARR)

(Calculated by comparison of IG with de-identified data from RDWA database)

Outcomes collected at

T1 = Pre-intervention

T2 = 3 months after intervention

T3 = 42 months after intervention

RDD reported T1 T2

ITL reported T1 T2

ARR reported T3

Intervention group (IG) n = 40

Control group n = 205

Of 69 GPs who volunteered to attend 48 completed post-intervention questionnaires T2 but only 40 were eligible due to inconsistencies in personal codes.

Missing – Number analysed in intervention group at T1 not specified.

CG Intention to leave at T2 = 10 IG Intention to leave at T2 = 3

Rural Doctor Distress (RDD)

IG v CG at baseline

Not significantly different p > 0.05

IG T1-T2

Significant t-test for all 10 items.

p = 0.05

Doctors’ intention to leave

IG T1-T2

Chi² p = 0.023

% intending to leave practice

CG v IG T1 v IG T2

47.5 % v 81.1 % v 40 %

Actual retention rate

IG v CG

93.9 % v 79.5 %

Chi² p = 0.027

Holt & Del Mar [36]

Australia

819 GPs respondents to questionnaire

233 GPs eligible for inclusion in study as had GHQ-12 ≥ 3

Of the 819 questionnaire respondents 552 were male.

No gender data on the 233 eligible for the intervention.

Questionnaire sent to 1356 GPs from 8 divisions in 2 Australian states.

Aim

Need for broader organizational approach to occupational stress

Format

Mailed intervention consisted of letter with feedback on GHQ score, interpretation of score and self-help sheet which addressed issues identified in baseline data.

Questionnaire respondents with GHQ-12 score ≥3 were divided into 2 groups.

Control group (CG) n = 113

Intervention group (IG) n = 120

Controlled trial

GHQ-12 item

Used to detect psychological distress and changes within the same population.

Scores classified as

0-2 = none to mild psychological distress

3-7 = mild to moderate

8-12 = moderate to severe.

Outcomes collected and reported at

T1 = pre-intervention/baseline

T2 = 3 months post-intervention

Intervention group

n = 78

Control group

n = 83

Analysed both as intention to treat and then excluding the 26 GPs who attended a concurrent educational programme.

Exclusions = 14 in the Intervention group who enrolled in a concurrent educational program that used similar material.

Lost to follow-up

IG T2 = 42

CGT2 = 30

GHQ-12 scores

Analysed by intention to treat

IG pre and post-intervention

Change = 3.39

CG pre and post-intervention

Change = 2.25

IG v CG

Difference of means 1.14 (0.07,2.27) p = 0.05

Analysed after excluding data from 26 GPs

Difference of means 1.44 (0.18, 2.7) p = 0.03

Results for GPs attending the educational program showed that 62 % scored ≤2 on GHQ-12

Martin Asuero et al. [37]

Spain

68 Primary care professionals elected to attend a mindfulness education programme.

Mean age 47

92 % women

60 % doctors

33.3 % nurses

6.7 % social workers and clinical psychologists.

Intervention group1 n = 21

Intervention group2 n = 22

Authors report no significant baseline differences in intervention groups.

Setting – Primary health care centres in Catalonia.

28 h over 8 weeks. Mindfulness-based group psychoeducational activities.

Aims

To assess the effectiveness of a training programme designed to reduce burnout and mood disturbance, to increase empathy and to develop mindfulness.

Format

Intervention was delivered by the same trained instructor to both intervention groups

Weekly sessions included educational presentations; formal mindfulness meditation; narrative and appreciative inquiry exercises and group discussion. There was an 8 h guided silent mindfulness session.

Materials/Homework

Participants paid $68 for packs containing a CD recording of exercises with an explanatory booklet. Home practice was expected.

25 Primary care professionals who were offered the intervention after study completion.

Controlled clinical trial

Maslach Burnout Inventory (MBI) 22items 3 subscales. Higher scores on emotional exhaustion and depersonalization; lower scores on personal accomplishment indicate a higher degree of burnout. Possible scores 0-140

Profile of mood states (POMS) Short version- 15 items- 5 subscales: tension-anxiety, depression-dejection, anger-hostility, vigour-activity, fatigue-inertia. Higher scores indicate a worse mood state (except vigour) Scores range from 0-60 morale.

Jefferson Scale of Physician Empathy (JSPE) 20 items 3 subscales. Higher scores on compassionate care, perspective taking and ‘standing in the patient’s shoes’ indicate higher degree of empathy

Five facets mindfulness questionnaire (FFMQ).

Observing, describing, acting with awareness, non-judging, non-reactivity rated on 5 point Likert where 1 = never/very rarely -5 = very often/always .39 items

Evaluation questionnaire

Translated into Spanish from University of Massachusetts Center for Mindfulness

All measured at baseline T1and 8/52 post-intervention T2

Intervention group (IG)

T1 = 43

T2 = 43

Control group(CG)

T1 = 25

T2 = 25

Exclusions 0

Withdrawals 0

Lost to follow-up

IG T2 = 0

CG T2 = 0

MBI

SRM IG = 0.43 CG = -0.11

Mean between group difference

-7 (-13.4 to -0.6 (95 % CI)) p < 0.05

SES 0.74

POMS

SRM IG = 0.62 CG = -0.1

Mean between group difference -0.71 (-11 to -3) p < 0.01

SES 1.15

JSPE

SRM IG = 0.31 CG = -0.24

Mean between group difference

5.2 (0.2 to 10.3) p < 0.05

SES 0.71

FFMQ

SRM IG = 0.65 CG = 0.1

Mean between group difference

11[3–19] p < 0.01

SES 0.9

SRM = standardized response mean. Calculated as mean change in score divided by the standard deviation of the change.

SES = standardized effect size. Calculated as mean difference between groups divided by standard deviation of the control group. Values > 0.8 = large changes