Critical Care Explorations (Jul 2022)

Defining Objective Measures of Physician Stress in Simulated Critical Communication Encounters

  • Amy H. J. Wolfe, MD, MEd,
  • Pamela S. Hinds, PhD,
  • Adre J. du Plessis, MD,
  • Heather Gordish-Dressman, PhD,
  • Robert M. Arnold, MD,
  • Lamia Soghier, MD, MEd

DOI
https://doi.org/10.1097/CCE.0000000000000721
Journal volume & issue
Vol. 4, no. 7
p. e0721

Abstract

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OBJECTIVES:. This study had three aims: 1) quantify the difference in stress levels between low and high stress roles during simulated critical communication encounters using objective physiologic data (heart rate variability [HRV]) and subjective measures (State-Trait Anxiety Inventory [STAI]), 2) define the relationship between subjective and objective measures of stress, and 3) define the impact of trainee preparedness and reported self-efficacy on stress levels. DESIGN:. Mixed methods simulation-based study. SETTING:. Single center. PATIENTS:. Pediatric critical care fellows and faculty (n = 12). INTERVENTIONS:. Subjects participated in six simulated scenarios in both high stress “hot seat” and low stress “observer” roles. MEASUREMENTS AND MAIN RESULTS:. Subjective stress was measured using the STAI at baseline and after each scenario. Objective stress was measured continuously using a wearable biometric device measuring HRV. Previous residency communication training and self-confidence surrounding various communication topics were collected via questionnaire. Significant changes in subjective (STAI) and objective stress (HRV) measurements in the low- versus high-stress roles were observed. STAI scores increased 8 points during low stress and 12 points during high stress role (p = 0.021) compared with baseline. Two specific HRV markers, root mean square of successive differences between normal heartbeats, a marker of parasympathetic tone, and the low frequency/high frequency (LF/HF) ratio, a marker of sympathetic activation, were significantly correlated with STAI levels (–0.032, p = 0.001; 1.030, p = 0.002, respectively). Participants who reported increased confidence in discussing code status had a significant decrease in stress response (measured via LF/HF ratio) during both the observer (p = 0.033) and hot seat roles (p = <0.001). CONCLUSIONS:. Communicating life-altering news in a simulated environment is a stressful experience. This stress results in physiologic changes that can be measured continuously using HRV. HRV measurement may serve as a novel method in evaluating the effectiveness of communication training programs and measuring future stress-reduction interventions.