Mindfulness-based interventions to reduce burnout and stress in physicians: A systematic review and meta-analysis

Background: Physicians often suffer from burnout and stress, which affects themselves, their patients, and the health care system in general. Studies suggest that mindfulness-based interventions (MBIs) improve physicians’ well-being as well as the quality of care they deliver. However, the evidence is scattered, and a systematic review and meta-analysis was lacking. Objectives: This systematic review and meta-analysis is the first to assess the effectiveness of MBIs in reducing burnout and stress among physicians. Research question(s) and/or hypothesis/es: (1) How effective are MBIs in reducing burnout and stress among physicians? (2) Do characteristics of the specific intervention, the tested population, or the study design influence the interventions’ effectiveness? Method: We 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. Additionally, we conducted backward and forward citation searches of related reviews and included studies. To find studies in the grey literature, we contacted authors of identified studies, conference abstracts, and relevant reviews. 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 the overall quality of evidence. We used random-effects modelling to calculate pooled effect sizes. To explore potential moderators, we conducted prespecified subgroup and sensitivity analyses and prespecified meta-regressions. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the quality of evidence. The study protocol is registered with PROSPERO (CRD42019133077) and published in BMJ Open. Results: Of 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 analysis (5 comparisons: standardized mean differences [SMD] = –0.26, 95% CI = –0.50; –0.03) and pre-post analysis (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 analyses (17 comparisons: SMD = –0.41, 95% CI = –0.61; –0.20). In pre-post analyses, treatment duration positively predicted stress reduction. Moreoever, increases in self-reported mindfulness marginally predicted both burnout and stress reduction. 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. Conclusions and implications: Current research data suggest that MBIs can reduce burnout and stress among physicians. This is important as there is a strong association between physicians’ well-being and the quality of care they deliver. Shortcomings in the quality of evidence highlight the need for high-quality controlled trials providing long-term follow-up data.