Abstract
Dear Editor:
Coronavirus disease 2019 (COVID-19) outbreak has spread worldwide for over one year. In the affected countries, clinicians have faced heavy workload conditions and high risk of infection.1–4 Nowadays, COVID-19 has been under better control but clinicians working with their routine patients still need to use caution in their daily practice. Therefore, the working conditions are more complex than before the COVID-19 surge. Both physical and psychological distress of clinicians should be monitored, but there are no a simple assessment tools to measure practitioner distress. We conducted a survey to explore and compare symptom distress through the Edmonton Symptom Assessment System (ESAS) 5 and burnout frequency through the Maslach Burnout Inventory-Medical Personnel (MBI) among clinicians working on the front lines (FL) of COVID-19 and their colleagues practicing in their usual wards (UWs).
Methods
The institutional review board approved the survey and protocol. As previously reported, 220 medical staff from Hubei Cancer Hospital participated in this study. 3 In addition, ESAS and MBI were given to all participants. The total number of questions was 49. The participants were assured of complete anonymity. Six different methods were utilized to measure burnout. The survey was completed between March 13, 2020, and March 17, 2020.
Statistical analysis
We applied standard descriptive statistics to summarize the response to all survey questions, including median, interquartile range, and range for continuous variables and frequency and proportion for categorical variables. Chi-squared test was used to assess the difference of frequencies of burnout between the FL and the UWs.
Results
A total of 190 (86%) completed the survey. Symptom distress was evaluated through ESAS (Table 1). Interestingly, participants from the UWs had a significantly higher degree of anxiety than those from the FL. Moreover, participants from the UWs also reported higher financial distress than those from the FL. The other 10 items did not differ significantly between the two groups. The burnout frequency was evaluated based on the six different criteria using MBI. The frequency of burnout was significantly lower in the FL group than in the UW group by all six criteria using MBI, as we previously reported. 3
Comparison of Medical Personnel in the Front Line with Those in the Usual Cancer Ward
The severity at the time of each symptom is rated from 0 to 10 on a numerical scale, with 0 indicating that a symptom is absent and 10 indicating that it is of the worst possible severity.
The most common method of MBI has been previously reported. 3
DP, depersonalization; EE, emotional exhaustion; ESAS, Edmonton System Assessment Scale; IQR, interquartile range; MBI, Maslach Burnout Inventory; PA, personal achievement; SDS, symptom distress scale.
Discussion
We have further confirmed our previous finding that when comparing those working in their UWs, clinicians working on the FL had a lower frequency of burnout. 3 We also found that UW staff had a lower intensity of anxiety and psychological distress on ESAS, making ESAS a potential assessment for medical staff who might face more distress after the surge of the COVID-19 crisis. ESAS is familiar to doctors and nurses and could be done within minutes. The MBI is the gold standard assessment for burnout, but it cannot reveal physical symptoms related to burnout.
Conclusion
ESAS, with 12 items, could be a candidate tool to evaluate symptom distress especially for those medical staff when MBI, the gold standard for burnout, is unavailable.