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BMJ Open Is Committed to Open Peer Review. As Part of This Commitment We Make the Peer Review History of Every Article We Publish Publicly Available BMJ Open: first published as 10.1136/bmjopen-2020-046599 on 18 August 2021. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay-per-view fees (http://bmjopen.bmj.com). If you have any questions on BMJ Open’s open peer review process please email [email protected] http://bmjopen.bmj.com/ on September 26, 2021 by guest. Protected copyright. BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-046599 on 18 August 2021. Downloaded from The effect of interventions for the wellbeing, satisfaction and flourishing of general practitioners – A systematic review ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2020-046599 Article Type: Original research Date Submitted by the 09-Nov-2020 Author: Complete List of Authors: Naehrig, Diana; The University of Sydney, The Faculty of Health and Medicine Schokman, Aaron; The University of Sydney, The Faculty of Health and Medicine Hughes, Jessica; The University of Sydney Library Epstein, Ronald; University of Rochester School of Medicine, Family Medicine Research Programs Hickie, Ian; The University of Sydney, Brain and Mind Centre Glozier, Nick; The University of Sydney, The Faculty of Health and Medicine PRIMARY CARE, GENERAL MEDICINE (see Internal Medicine), MENTAL Keywords: HEALTH, Organisational development < HEALTH SERVICES http://bmjopen.bmj.com/ ADMINISTRATION & MANAGEMENT on September 26, 2021 by guest. Protected copyright. 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Downloaded from 4 TITLE PAGE 5 6 Title The effect of interventions for the wellbeing, satisfaction, and flourishing 7 of general physicians – A systematic review 8 Authors Diana Naehrig, ORCID (0000-0002-1162-4092), 9 10 Dr.med., FMH Radioonkologie, MSc Coach Psych, 11 PhD candidate, The University of Sydney, Faculty of Health and Medicine, 12 Level 5, Professor Marie Bashir Centre, Missenden Road, Camperdown, 13 NSW 2050, Australia, [email protected]; 14 15 Aaron Schokman, ORCID (0000-0003-0419-9347), BSc, MPhil, 16 17 PhD candidate, The University of Sydney, Faculty of Health and Medicine, 18 ForLevel 5,peer Professor Mariereview Bashir Centre, only Missenden Road, Camperdown, 19 NSW 2050, Australia, [email protected]; 20 21 Jessica Kate Hughes, ORCID (0000-0003-0046-1686), Master of 22 Information Studies, Assistant Librarian, The University of Sydney 23 Library, Rm 202, Fisher Library F03, The University of Sydney, NSW 24 25 2006, Australia, [email protected]; 26 27 Ron Mark Epstein, ORCID (0000-0002-3564-9163), MD 28 Co-Director, Center for Communication and Disparities Research, 29 Professor of Family Medicine, Oncology and Medicine (Palliative Care), 30 American Cancer Society of Clinical Research Professor, University of 31 Rochester School of Medicine and Dentistry, 1381 South Avenue, 32 33 Rochester, NY 14620, USA, [email protected]; 34 35 Ian Hickie, ORCID (0000-0001-8832-9895), AM MD FRANZCP FASSA 36 FAHM 37 Co-Director, Health and Policy and Professor of Psychiatry, NHMRC http://bmjopen.bmj.com/ 38 Senior Principal Research Fellow, The University of Sydney, Faculty of 39 40 Health and Medicine, Brain and Mind Centre, Level 4, Building F, 94 41 Mallett Street, Camperdown, NSW 2050, Australia, 42 [email protected]; 43 44 Nick Glozier, ORCID (0000-0002-0476-9146), 45 Professor of Psychological Medicine, The University of Sydney, Faculty of on September 26, 2021 by guest. Protected copyright. 46 Health and Medicine, Central Clinical School, Level 5, Professor Marie 47 48 Bashir Centre, Missenden Road, Camperdown, NSW 2050, Australia, 49 [email protected] 50 Corresponding Diana Naehrig, The University of Sydney, Faculty of Health and Medicine, 51 author Level 5, Professor Marie Bashir Centre, Missenden Road, Camperdown, 52 NSW 2050, Australia, [email protected] 53 54 55 Word count 3262 56 manuscript 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 40 BMJ Open 1 2 3 BMJ Open: first published as 10.1136/bmjopen-2020-046599 on 18 August 2021. Downloaded from 4 ABSTRACT 5 6 7 Objectives 8 Clinician wellbeing has been recognised as an important pillar of health care. However, 9 research mainly addresses mitigating the negative aspects of stress or burnout, rather 10 than enabling positive aspects. With the added strain of a pandemic, identifying how 11 best to maintain and support the wellbeing, satisfaction and flourishing of frontline 12 doctors is now more important than ever. 13 14 15 Design 16 We systematically reviewed the effect of any type of intervention on wellbeing, and 17 related positive outcomes in General Practitioners (GPs). 18 For peer review only 19 Data sources 20 We searched MEDLINE, PsycINFO, Embase, CINAHL, and Scopus from 2000 to 21 22 2020. 23 24 Study selection 25 Studies with more than 50% GPs, trialling any type of intervention, looking at 26 wellbeing, satisfaction, flourishing and related positive outcomes were included. The 27 Cochrane risk of bias 2 tool was applied. 28 29 30 Results 31 Data Extraction 32 We retrieved 14,792 records, 94 studies underwent full text review. We included 19 33 studies in total. Six randomised controlled trials, three non-randomised, controlled 34 trials, and eight non-controlled studies. There were a total of 1141 participants, with 35 interventions targeting individuals or organisations, plus two quasi-experimental articles 36 37 evaluating health system policy change. http://bmjopen.bmj.com/ 38 39 Data synthesis 40 Individual mindfulness interventions were the most common (k=9) with medium to 41 large within (0.37-1.05) and between group (0.5-1.5) effect sizes for mindfulness 42 outcomes, and small to medium effect sizes for a range of other positive outcomes 43 including resilience, compassion, and empathy. Studies assessing other interventions or 44 45 positive outcomes (including wellbeing, satisfaction) were of limited size and quality. on September 26, 2021 by guest. Protected copyright. 46 47 Conclusions 48 There is remarkably little evidence on how to improve PCP wellbeing beyond using 49 mindfulness interventions, particularly interventions addressing organisational or 50 system factors. This was further undermined by inconsistent reporting, and overall high 51 52 risk of bias. We need to conduct research in this space with the same rigour with which 53 we approach clinical intervention studies in patients.
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