Burnout and long COVID among the UK nephrology workforce: results from a national survey...., 2022, Selvaskandan et al

[Andy]

Full title: Burnout and long COVID among the UK nephrology workforce: results from a national survey investigating the impact of COVID-19 on working lives

ABSTRACT

Background
The coronavirus disease 2019 (COVID-19) pandemic is placing a significant strain on healthcare. We conducted a national survey of the UK nephrology workforce to understand its impacts on their working lives.

Methods
An online questionnaire incorporating the Maslach Burnout Inventory score was distributed between 31 March and 1 May 2021, with a focus on COVID-19 and long COVID incidence, vaccine uptake, burnout and working patterns. Data were analysed qualitatively and quantitatively; multivariable logistic regression was used to identify associations.

Results
A total of 423 responses were received. Of them, 29% had contracted COVID-19, which was more common among doctors and nurses {odds ratio [OR] 2.18 [95% confidence interval (CI) 1.13–4.22]} and those <55 years of age [OR 2.60 (95% CI 1.38–4.90)]. Of those who contracted COVID-19, 36% had symptoms of long COVID, which was more common among ethnicities other than White British [OR 2.57 (95% CI 1.09–6.05)]. A total of 57% had evidence of burnout, which was more common among younger respondents [OR 1.92 (95% CI 1.10–3.35)] and those with long COVID [OR 10.31 (95% CI 1.32–80.70)], and 59% with reconfigured job plans continued to work more hours. More of those working full-time wished to retire early. A total of 59% experienced remote working, with a majority preference for continuing this in the future. In terms of vaccination, 95% had received one dose of a COVID-19 vaccine and 86% had received two doses by May 2021.

Conclusions
Burnout and long COVID is prevalent with impacts on working lives. Some groups are more at risk. Vaccination uptake is high and remote and flexible working were well received. Institutional interventions are needed to prevent workforce attrition.

Open access, https://academic.oup.com/ckj/article/15/3/517/6460510

 

[Hutan]

The UKKA represents nephrology-affiliated HCPs including doctors, nurses, technicians, pharmacists, psychologists and social workers [2]. ... Responses were accepted between 31 March and 1 May 2021

Long COVID was defined as persistent symptoms following acute COVID-19. Those with symptom resolution within 3 months were excluded.

36% with symptoms of Long Covid from 423 responses. Gosh, although almost certainly there is a self-selection bias. They say they can't determine a response rate, but they don't even try to estimate the work force size.

Of those who had COVID-19, 36% (43/120) had persistent symptoms consistent with long COVID. Fatigue was most common [70% (30/43)], followed by mood changes (19%) and ageusia/anosmia (14%). Major impacts of long COVID on quality of life and work were reported

I thought this was worth commenting on. Here are the relevant questions relating to Long Covid:

3. If you have had COVID and have long-term symptoms, could you describe the impact this is having on your personal and/or professional life?

Yep, that's it. One. The percentage of symptoms experienced is taken from free text responses to that question. I mean, if you were asked to give a brief comment on the impact ME/CFS is having on your personal and/or professional life, would you respond with a careful list of the symptoms you are experiencing? It's great that the authors decided to survey the workforce, but I really hope that, if they repeat it, they take a more rigorous approach to asking about Long Covid. Or they don't attempt to present information about LC symptom frequency.

Crucially, those with long COVID were 10 times more likely to experience burnout. Although pathways for managing long COVID are beginning to emerge [43], institutional support for HCPs with long COVID is needed to prevent workforce attrition.

Although there was an association between burnout and Long Covid, this might be mostly just an overlap in criteria. The burnout scales included emotional exhaustion and low personal accomplishment - someone with debilitating fatigue might easily score high on those things.

 

[Hutan]

While I commend the authors for undertaking this survey, there are some issues with the analysis related to Long Covid.

Despite the title suggesting a focus on Long Covid, the survey on which the paper is based has only one question about it:
“If you have had COVID and have long-term symptoms, could you describe the impact this is having on your personal and/or professional life?”
This question is unlikely to elicit a careful and comprehensive listing of symptoms experienced. Indeed, looking at the list of free text answers provided, it did not. Despite this, the paper reports the frequency of the three most common symptoms mentioned, with ‘mood changes’ in 19% of the respondents reporting chronic symptoms. The actual responses to the question, such as ‘Stressful and worried’ make it clear that at least some of the ‘mood changes’ are the normal secondary effects of being in the early stages of a debilitating chronic illness.

When researching Long Covid, it is helpful to differentiate those people meeting the criteria for ME/CFS, a condition occurring after a range of infections with the key symptom of post-exertional malaise, from those with other symptoms such as coughing or PTSD from hospitalisation, as the requirements for support and treatment will be quite different.

An estimate of the size of the nephrology workforce would have given a boundary to the survey response rate, and so provide an indication of the potential issue with self-selection.

The paper notes a strong association between burnout and Long Covid, potentially leaving some readers with the impression that burnout causes Long Covid, or that Long Covid is a type of burnout. However, it is likely that the tool used for assessing burnout is not sufficiently sensitive to differentiate well between the two. For example, someone suffering from debilitating fatigue is likely to have problems with low personal achievement and emotional exhaustion which are two of the three aspects assessed when quantifying burnout.

The topic of post-Covid-19 chronic symptoms in health workforces is an important one, and again I commend the authors for having the foresight to investigate it. Liaison with Long Covid and ME/CFS patient organisations when developing surveys can help make the outcome of such research more useful.

I've submitted the comment above. It was surprisingly easy to register and submit a comment.

 

[Trish]

Excellent comment Hutan. It's very concerning how useless some people are at designing surveys that will provide accurate and useful information.