Mindfulness-Based Interventions to Reduce Burnout and Stress in Physicians: A Systematic Review and Meta-Analysis.

Abstract

PURPOSE\nTo perform a systematic review and meta-analysis of studies evaluating the effectiveness of mindfulness-based interventions (MBIs) in reducing burnout and stress among physicians.\n\n\nMETHOD\nThe authors searched records in MEDLINE, Embase, PsycINFO, PSYNDEX, Web of Science, CINAHL, and CENTRAL from database inception to August 8, 2019, using combinations of terms for mindfulness, interventions, and physicians. Eligible studies were randomized controlled trials (RCTs) and non-randomized trials (NRTs), including controlled and non-controlled before-after studies, all assessing burnout and stress among physicians pre- and post-intervention via validated instruments. Two reviewers independently screened records, extracted data, assessed risk of bias, and rated overall quality of evidence. The authors used random-effects modelling to calculate pooled effect sizes and conducted prespecified subgroup and sensitivity analyses to explore potential moderators.\n\n\nRESULTS\nOf 6,831 identified records, 25 studies (with 925 physicians) were ultimately included. MBIs were associated with significant small reductions in burnout in the between-group (5 comparisons: standardized mean differences [SMD] = -0.26, 95% CI = -0.50; -0.03) and pre-post analyses (21 comparisons: SMD = -0.26, 95% CI = -0.37; -0.15), and with a significant medium reduction in stress in the between-group analysis (4 comparisons: SMD = -0.55, 95% CI = -0.95; -0.14) and a significant small reduction in stress in the pre-post analysis (17 comparisons: SMD = -0.41, 95% CI = -0.61; -0.20). Versions of established MBIs showed higher effectiveness in reducing stress than other forms of MBIs or a mindfulness app. Reductions were maintained over an average follow-up of 5.3 months. The risk of bias was moderate with RCTs and high with NRTs. The overall quality of evidence was low to very low.\n\n\nCONCLUSIONS\nMBIs can be effective in reducing physicians burnout and stress. Shortcomings in the quality of evidence highlight the need for high-quality controlled trials providing long-term follow-up data.