Supporting the well-being of health care providers during the COVID-19 pandemic: The CopeColumbia response

May combine two claims.

The COVID-19 pandemic heavily burdened medical centers and worsened the mental health strain on health care workers.

“COVID-19 is an international public health crisis, putting substantial burden on medical centers and increasing the psychological toll on health care workers (HCW).”

• Also stated in: § Introduction · hedged

  “Compounding resource challenges was the potential emotional toll on health care workers (HCW), particularly those on the frontline [[6], [7], [8], [9], [10]].”

• cites [6] sourcePartly supported

  The opening section (p. 1) calls COVID-19 a massive global health crisis that places significant psychological burdens on individuals. “Aligning individual and collective interests” (p. 6) discusses scarce health-care resources and the possibility of ventilator demand exceeding capacity. Neither passage establishes that medical centers were substantially burdened or that health-care workers specifically experienced an increased psychological toll. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites [7] sourceSupported
• cites [8] sourcePartly supported

  The Introduction describes rising case numbers, overwhelming workloads, and factors that may contribute to health care workers’ mental burden. The Discussion reports high rates of mental health symptoms among surveyed workers in China. But the Limitations note that this cross-sectional study could not distinguish preexisting from new symptoms, so it does not establish that COVID-19 increased the psychological toll over time. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Increased distress accompanied the recognition that COVID-19 infection and mortality rates were highest among racial and ethnic minorities, reflecting pre-existing racial and social disparities in healthcare.

“Finally, as described by others [40], increased distress accompanied the recognition that COVID-19 infection and mortality rates were highest in racial and ethnic minorities, reflecting pre-existing racial and social disparities in healthcare.”

• cites [40] sourcePartly supported

  The Conclusion (page not provided) reports that Black residents had higher COVID-19 infection and death rates relative to their share of Connecticut’s population, and links vulnerability to a history of discrimination. It does not say that racial and ethnic minorities had the highest rates generally, or that recognizing the disparities was accompanied by increased distress. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

New workflows, including much greater use of telemedicine and social distancing plans, are being implemented amid concerns about work-life balance.

“New workflows, including vastly increased use of telemedicine and ongoing social distancing plans are being implemented with concerns about work-life balance.”

Probably not a substantial claim: may not pass S3 (load-bearing).

36% of respondents said they had been tested for COVID-19.

“36% said they had been tested”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The groups initially targeted attending physicians and residents but quickly expanded to all CUIMC clinical and non-clinical staff.

“Although initially focused on attending physicians and residents, they quickly expanded to include all CUIMC clinical and non-clinical staff.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Across all weeks through June 26, 124 participants completed the survey.

“Across all weeks up through June 26, 124 participants completed the survey.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The emotional response amplified and focused the distressing emotions health care workers had expressed up to that point.

“In many ways, the emotional response represented an amplification and focusing of the distressing emotions expressed by HCW up to that point.”

Probably not a substantial claim: may not pass S3 (load-bearing).

After protests and social unrest related to societal racism, there was much discussion about the destructive effects and emotional toll of structural racism on providers, especially providers of color.

“Relatedly, in the wake of the protests and social unrest related to societal racism, there was much discussion about the destructive effects and the emotional toll of structural racism on providers, particularly providers of color.”

May combine two claims.

Health care workers served as liaisons to patients' families, using communication devices so relatives could talk to patients, set healthcare directives, and sometimes say goodbye.

“HCW became liaisons to patients' families, holding communication devices that enabled loved ones to talk to patients, establish healthcare directives, and sometimes say goodbye.”

May combine two claims.

Similar themes appeared across CopeColumbia services, and recommended coping strategies changed as the pandemic progressed.

“Across CopeColumbia services, thematic similarities emerged, with suggested strategies for coping evolving with the pandemic.”

Probably not a substantial claim: may not pass S3 (load-bearing).

As the surge has decreased, the institution and the community are reorienting toward reopening and the future.

“As the surge has ebbed, the institution, like the community, is reorienting toward re-opening and the future.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Acceptance of a new normal of ongoing uncertainty is taking hold.

“acceptance of a “new normal” of ongoing uncertainty is taking hold.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Deep sadness, anger, and confusion about how this could happen were compounded by grief and guilt about whether the death could have been prevented, along with recognition of exhaustion and fears about each other's mental health.

“Deep sadness, anger, and confusion about how this could happen were compounded by grief and guilt focused on how this death may have been prevented, as well as acknowledgement of everyone's exhaustion and fears about each other's mental health.”

May combine two claims.

As the surge neared, anticipatory anxiety and fear rose regarding competence in new roles with limited training, rapid patient volume increases, insufficient PPE, and possible care rationing with ethical dilemmas.

“As “the surge” approached and talk increased of redeployment to the “front lines”, so too did anticipatory anxiety and fear about: a) competence to serve in new roles with limited training; b) rapid increases in patient volume and associated demands; c) insufficient PPE; and d) possible rationing of care with resulting ethical dilemmas [21].”

• cites [21] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The loss was felt broadly across the medical center.

“The loss was felt broadly across the medical center.”

May combine two claims.

Group series lasted from 1 to 13 meetings; 30 groups met once, 22 met 2-4 times, and 9 met at least 5 times.

“Although initially presented as single sessions, group participants and facilitators determined the need/desire for additional meetings, which ultimately ranged from 1 to 13; 30 groups met once, 22 groups met 2–4 times and 9 groups met ≥5 times.”

May combine two claims.

Some departments used CopeColumbia more than others, usually because a leader advocated for well-being efforts and included CopeColumbia programming in their teams.

“Some departments utilized CopeColumbia more than others, typically because someone in a leadership role advocated for well-being efforts and included CopeColumbia programming among their teams.”

May combine two claims.

Health care workers described these moments as extremely sad but also deeply meaningful.

“HCW described these moments as excruciatingly sad, but also deeply meaningful.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Rising case rates, CUIMC caseloads, and deaths during the peak, along with post-surge experiences, marked three phases: pandemic onset, surge, and reintegration/recovery.

“Between March and June, increasing case rates, CUIMC caseloads and deaths during the height of the pandemic, and post surge experiences demarcated different phases of experience. For ease of presentation, we present key issues/themes and facilitator responses in the text and in Table 1, organized by three phases: (1) the pandemic begins, (2) the surge, and (3) reintegration and recovery.”

May combine two claims.

The daily 7 PM cheering for health care workers was meaningful to some but caused guilt in others who felt they were not meeting professional ideals.

“The daily 7 PM cheering for HCW that quickly established itself as a hallmark of NYC's gratitude, while meaningful for some, became a source of guilt for others struggling to live up to professional ideals.”

May combine two claims.

Some health care workers expressed anger, moral distress from lacking known treatments or ways to prevent deaths, or numbness.

“Some HCW expressed anger, feelings of moral distress as healers without known treatments or ways to prevent so many deaths, or feeling numb.”

May combine two claims.

Although respondents were concerned about their own health, their main concern was the health of family members.

“While individuals were concerned about their own health, their primary concern was the health of family members (Table 2 ).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Fears about contagion and its ongoing effects remain, including difficulty social distancing on mass transit and in small spaces like elevators.

“Fears about contagion and its ongoing impact remain, including the difficulty of socially distancing on mass transit and in small spaces like elevators.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In physician groups, faculty and residents usually met in separate groups.

“Among physician groups, faculty and residents mostly met separately.”

May combine two claims.

Some health care workers separated from family, which increased isolation and reduced social support.

“Some HCW segregated themselves from family members, increasing isolation and decreasing social support.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health care workers who have been on the front lines have a profound sense of exhaustion.

“For HCW who have been at the front lines, there is also a profound sense of exhaustion.”

May combine two claims.

Grief, loss, and trauma were major themes because of severe illness and many patient deaths, worsened by personal losses of family and friends.

“Themes of grief, loss, and trauma loomed large due to the severity of illness and volume of patient deaths and compounded by personal losses of family members and friends.”

May combine two claims.

Some health care workers worked remotely because of personal risk or because they were considered non-essential.

“Others worked remotely due to personal risk or being considered “non-essential” HCW.”

Probably not a substantial claim: may not pass S3 (load-bearing).

For health care workers still on the front lines, the pandemic remains present.

“But for those still on the front lines, the pandemic remains present.”

May combine two claims.

From March 23 to June 26, 2020, CopeColumbia held 186 groups with 1-30 participants each, covering 40 CUIMC departments, plus 43 Town Halls with more than 1500 participants and 141 One-to-One calls.

“Between March 23 and June 26th, 2020, 186 groups, consisting of 1–30 participants and representing 40 CUIMC departments were conducted (in addition to 43 Town Halls, with over 1500 participants in total, and 141 One-to-One calls).”

May combine two claims.

Health care workers often put patient needs before their own self-care and may worry about stigma attached to mental health care.

“HCW tend to place their own self-care secondary to the needs of their patients and may be sensitive to the stigma of mental health care [20,21].”

• cites [20] sourceNot checked — no full text of the source
• cites [21] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The Institutional Review Board determined that this work did not require Human Subjects Review.

“The Institutional Review Board did not consider this work in need of Human Subjects Review.”

May combine two claims.

Although the program is grounded in data-driven principles, the team cannot identify which components were most helpful.

“While grounded in data-driven principles, we cannot identify which components may have been the most helpful”

Probably not a substantial claim: may not pass S3 (load-bearing).

The team did not extensively advertise beyond its initial outreach efforts.

“We did not extensively advertise beyond our initial outreach efforts.”

May combine two claims.

The team did not objectively or systematically assess pre-post changes in psychological well-being, so it cannot definitively comment on CopeColumbia's impact.

“However, we did not objectively or systematically assess changes in psychological well-being pre and post intervention, thus cannot definitively comment on the impact of CopeColumbia.”

May combine two claims.

There is probably a continuing need for well-being programs and for connections to mental health services for health care workers.

“Lessons learned include: (1) there is likely an ongoing need for both well-being programs and linkages to mental health services for HCW”

• AssumptionRests on an assumption: The emotional themes and needs observed among CopeColumbia participants represent those of the broader CUIMC health care workforce.

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

Organizational backing is essential for sustaining programs such as CopeColumbia.

“organizational support for programs like CopeColumbia is critical for sustainability.”

May combine two claims.

The team does not know the full set of potential respondents and cannot calculate a response rate.

“Therefore, we don't know the universe of potential respondents and cannot calculate the response rate.”

May combine two claims.

Those psychological responses appeared soon after the event and, in some cases, after the acute crisis had passed.

“These responses have occurred both immediately after an event and, for some, after the acute crisis dissipated [12,13].”

• cites [12] sourceNot checked — no full text of the source
• cites [13] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

It is unknown whether the program offers a distinct benefit compared with psychological first aid.

“Psychological first aid (PFA) principles are consistent with many of our recommended interventions, but whether our program offers distinct benefit compared to PFA is unknown.”

Classified as probably not a substantial claim.

Participants in recurring groups may have completed the survey more than once.

“Participants in recurring groups may have completed the survey multiple times.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The survey collected no personal identifying information, and no chart notes were taken for the groups.

“No personal identifying information was collected in the survey and no chart notes were taken on the groups.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Despite efforts to address barriers, many health care workers in need likely did not participate.

“Despite these efforts, there were likely many in need who did not participate.”

May combine two claims.

Preliminary survey data were encouraging and suggest that the intervention was perceived as helpful.

“Preliminary survey data were encouraging, suggesting that our intervention was perceived as “helpful.””

Probably not a substantial claim: may not pass S3 (load-bearing).

Because the survey was anonymous, the team cannot determine how many unique participants the 124 responses represent.

“Due to the anonymity of the survey, we cannot identify how many unique participants this represents.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Important clinical observations or interventions that might have occurred in person were likely missed because participants were not fully visible or did not use video.

“It is likely that there are important clinical observations (e.g., body language) or interventions that might have occurred if our groups had been in-person yet were missed because participants were not in full view or did not use video.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The team cannot know whether these missed opportunities affected outcomes.

“We cannot know whether these missed opportunities contributed to a changed outcome.”

May combine two claims.

The team did not encounter an acutely distraught or suicidal participant and had safety plans for suicidality or self-harm, but it remains uncertain how safety can be effectively addressed virtually.

“Although we were not presented with an acutely distraught or suicidal participant and we did have safety plans in place for addressing suicidality/self-harm, it gives us pause to think about how issues of safety can be effectively addressed virtually.”