Tait Shanafelt

• Mayo Clinic

Importance Limited qualitative studies exist evaluating ambient artificial intelligence (AI) scribe tools. Such studies can provide deeper insights into ambient AI implementations by capturing lived experiences. Objective To evaluate physician perspectives on ambient AI scribes. Design, Setting, and Participants A qualitative study using semistru...

Objectives To quantify utilization and impact on documentation time of a large language model-powered ambient artificial intelligence (AI) scribe. Materials and Methods This prospective quality improvement study was conducted at a large academic medical center with 45 physicians from 8 ambulatory disciplines over 3 months. Utilization and document...

Objective This study evaluates the pilot implementation of ambient AI scribe technology to assess physician perspectives on usability and the impact on physician burden and burnout. Materials and Methods This prospective quality improvement study was conducted at Stanford Health Care with 48 physicians over a 3-month period. Outcome measures inclu...

Objectives Providing clinical performance feedback to physicians is an established method to improve care, but the impact on physician well-being is unclear. This evaluation aimed to better understand physician perspectives on clinical feedback and its potential impact on well-being. Design A qualitative design using semi-structured interviews was...

SF3B1 mutations are recurrent in chronic lymphocytic leukemia (CLL), particularly enriched in clinically aggressive stereotyped subset #2. To investigate their impact, we conducted RNA-sequencing of 18 SF3B1MUT and 17 SF3B1WT subset #2 cases and identified 80 significant alternative splicing events (ASEs). Notable ASEs concerned exon inclusion in t...

This Viewpoint summarizes methods used by health care organizations to assess and improve clinician well-being, discusses the potential downsides of public reporting of clinician well-being survey data, and calls for making organizations’ adherence to structure and process measures a part of accreditation criteria.

Importance The emergence and promise of generative artificial intelligence (AI) represent a turning point for health care. Rigorous evaluation of generative AI deployment in clinical practice is needed to inform strategic decision-making. Objective To evaluate the implementation of a large language model used to draft responses to patient messages...

Goal The objective of this study was to evaluate satisfaction with work–life integration (WLI), social isolation, and the impact of work on personal relationships (IWPR) among senior healthcare operational leaders. Methods Between June 7 and June 30, 2021, we performed a national survey of CEOs and other senior healthcare operational leaders in th...

Objectives Dentists’ well-being is being challenged today by many factors. However, effective screening tools to assess their distress and well-being are yet to be validated. The present study aims to evaluate the ability of the Well-Being Index (WBI) to identify distress and stratify dentists’ well-being and their likelihood for adverse profession...

Importance: Understanding of the interplay between the electronic health record (EHR), health care team relations, and physician well-being is currently lacking. Approaches to cultivate interpersonal interactions may be necessary to complement advancements in health information technology with high-quality team function. Objective: To examine wa...

Low count (LC) MBL is characterized by a circulating population of clonal B-cells and is a precursor state to CLL. Most individuals with LC MBL do not progress to CLL and never come to clinical attention. An active area of research is to identify factors that distinguish those individuals with MBL who progress from those who do not. Currently, 41 s...

This Viewpoint discusses the need for public funding for research that supports health workforce well-being and addresses occupational burnout among health care practitioners.

Introduction: Multiple national studies suggest that, among physicians, physiatrists are at increased risk for occupational burnout. Objective: Identify characteristics of the work environment associated with professional fulfillment and burnout among U.S. physiatrists. Design: Between May and December 2021, a mixed qualitative and quantitativ...

Objective To examine how perceived leadership behaviours affect burnout, professional fulfilment and intent to leave the organisation among physicians. Design Anonymous cross-sectional survey study from November 2016 to October 2018. Setting 12 036 attending and resident physicians at 11 healthcare organisations participating in the Physician Wel...

Importance: Reducing physician occupational distress requires understanding workplace mistreatment, its relationship to occupational well-being, and how mistreatment differentially impacts physicians of diverse identities. Objectives: To assess the prevalence and sources of mistreatment among physicians and associations between mistreatment, occ...

Importance: Burnout is common among physicians and is associated with suboptimal patient outcomes. Little is known about how experiences with patients, families, and visitors differ by physician characteristics or contribute to the risk of burnout. Objective: To examine the occurrence of mistreatment and discrimination by patients, families, and...

Monoclonal B-cell lymphocytosis (MBL) is one of the most common pre-malignant conditions and is characterized by a circulating population of clonal B-cells with an absolute clonal B-cell count < 5x10 9/L and no evidence of lymphadenopathy, organomegaly, or cytopenias. MBL can be classified by the immunophenotype: CLL-like MBL (CD5+, CD20dim), atypi...

Introduction Monoclonal B-cell lymphocytosis (MBL), monoclonal gammopathy of undetermined significance (MGUS), and clonal hematopoiesis (CH) are three common premalignant hematological conditions. MBL is a precursor to chronic lymphocytic leukemia (CLL), MGUS is a precursor to both multiple myeloma (MM) and Waldenström macroglobulinemia (WM), and C...

Background: The ECOG-ACRIN randomized phase 3 clinical trial E1912 established ibrutinib-rituximab (IR) as the standard of care for CLL patients <= 70 years in the frontline setting by improving the progression free (PFS) and overall survival (OS) compared to previous standard chemo-immunotherapy with fludarabine, cyclophosphamide and rituximab (FC...

Purpose: Although previous studies have revealed professional consequences of burnout among nurses, less is known about the potential personal consequences. This study investigated the prevalence of suicidal ideation and attitudes toward help seeking among U.S. nurses relative to other workers, and the extent to which personal and professional fac...

Context Nearly 20% patients are ≥80 years of age at CLL diagnosis. Increased comorbidities often accompany advanced age. However, clinical trials enroll a disproportionally low number of people this age, providing limited evidence for guidance. Objective To determine clinical characteristics and outcomes of patients ≥80 years of age at the time of...

Objective: To understand the relationships between burnout, job satisfaction, and career plans among physician assistants in the United States. Methods: The authors surveyed PAs in 2016. The survey included the Maslach Burnout Inventory and items on job satisfaction and career plans. Results: Overall 82.7% of PAs were satisfied with their job,...

Objective: To compare physicians with workers in other fields on measures of self-valuation (SV) and determine the effect of adjusting for SV on the relationship between being a physician and risk for burnout. Patients and methods: A random sample of physicians from the American Medical Association Physician Masterfile and a probability sample f...

Even before the onset of the Covid-19 pandemic, clinician burnout was a recognized occupational syndrome and a driver of suboptimal patient care. National calls for system-level interventions to improve clinician well-being led some health care organizations (HCOs) to appoint a Chief Wellness Officer (CWO). By incorporating CWOs into the emergency...

Background Prior work has shown that burnout among breast surgeons is prevalent and highest in those earlier in their clinical practice career. Therefore, we sought to better understand and identify specific contributors to early-career breast surgeon burnout. Methods We analyzed data from our 2017 survey of members of the American Society of Breas...

Objectives: To measure nurse-perceived electronic health records (EHR) usability with a standardized metric of technology usability and evaluate its association with professional burnout. Methods: A cross-sectional survey of a random sample of US nurses was conducted in November 2017. EHR usability was measured with the System Usability Scale (S...

These are challenging times for physicians. Extensive changes in the practice environment have altered the nature of physician's interactions with patients and their role in the health care delivery system. Many physicians feel as if they are "cogs in the wheel" of austere corporations that care more about productivity and finances than compassion...

INTRODUCTION Nearly 20% of patients (pts) are ≥ 80 years (yrs) of age at the time of CLL diagnosis. Increased medical comorbidities, as well as declining functional status and organ function, often accompany advanced age. However, clinical trials often enroll a disproportionally low number of people from this age demographic due to stringent eligib...

Background MBL is a precursor to chronic lymphocytic leukemia (CLL) and is subclassified into low-count (LC) MBL (absolute B-cell count<0.5x109/L) and high-count (HC) MBL (absolute B-cell count between 0.5 and 5x109/L). We previously reported that a polygenic risk score (PRS) based on a weighted average of 41 CLL-susceptibility variants was associa...

Background: There is a high prevalence of burnout among health care professionals, but little remains known about burnout and satisfaction with work-life integration (WLI) among advance practice nurses (APNs). Purpose: To evaluate burnout and satisfaction with WLI among APNs compared with other US workers. Methods: A national sample of APNs an...

Objective: To evaluate the relationship between burnout and professional behaviors and beliefs among US nurses. Methods: We used data from 2256 nurses who completed a survey that included the Maslach Burnout Inventory and items exploring their professional conduct (documented something they had not done so they could 'close out' an encounter in...

Background Electronic health record (EHR) usability and physician task load both contribute to physician professional burnout. The association between perceived EHR usability and workload has not previously been studied at a national level. Better understanding these interactions could give further information as to the drivers of extraneous task l...

BACKGROUND Electronic health record (EHR) usability and physician task load both contribute to physician professional burnout. The association between perceived EHR usability and workload has not previously been studied at a national level. Better understanding these interactions could give further information as to the drivers of extraneous task l...

Background Well-being and distress are important issues in the pharmacist workforce; yet, there is limited evidence evaluating the validity of practical screening tools among pharmacists. Objectives To evaluate the ability of the Well-Being Index (WBI) to (1) identify the well-being and dimensions of distress in pharmacists, and (2) stratify pharm...

This cross-sectional survey assesses the association of perceived electronic health record usability with patient interaction and work-life integration among US physicians.

Objective: To evaluate burnout and satisfaction with work-life integration among physician assistants (PAs) compared with other US workers. Methods: We surveyed PAs and a probability-based sample of US workers. The survey included the Maslach Burnout Inventory and an item on satisfaction with work-life integration. Results: Overall, 41.4% of P...

Purpose: To explore whether burnout is an independent predictor of career choice regret among nurses. Methods: In November 2017 we invited a random sample of 89,995 members of the American Nurses Association to participate in an anonymous online survey. The survey collected demographic and professional information and included the Maslach Burnou...

Occupational distress among clinicians and its impact on quality of care is a major threat to the health care delivery system. To address threats to clinician well-being, many institutions have introduced a new senior leadership position—the health care chief wellness officer (CWO). This role is distinct from CWOs or other wellness leadership posit...

Clinician burnout and patient experience are important issues that are often considered separately. New measures of resilience may influence both. We explored relationships among clinician resilience, burnout, and patient experience. Analysis included 490 physicians who completed surveys measuring burnout and resilience (decompression and activatio...

Background Despite the importance of professionalism, little is known about how burnout relates to professionalism among practicing physicians. Objective To evaluate the relationship between burnout and professional behaviors and cost-conscious attitudes. Design and Participants Cross-sectional study in a national sample of physicians of whom a f...

Objective: To describe and benchmark physician-perceived electronic health record (EHR) usability as defined by a standardized metric of technology usability and evaluate the association with professional burnout among physicians. Participants and methods: This cross-sectional survey of US physicians from all specialty disciplines was conducted...

Background: Whether health care provider burnout contributes to lower quality of patient care is unclear. Purpose: To estimate the overall relationship between burnout and quality of care and to evaluate whether published studies provide exaggerated estimates of this relationship. Data sources: MEDLINE, PsycINFO, Health and Psychosocial Instru...

Background Physician burnout is a well-recognized problem in health care that has a negative impact on professional well-being and quality of patient care. Rates of burnout in breast surgery are not well-defined. This study sought to understand the degree of burnout among breast surgeons and to identify factors that influence professional fulfillme...

Objectives: To evaluate characteristics associated with burnout and satisfaction with work-life integration (WLI) among nurses and compare their experience to other American workers. Methods: We used data from 8638 nurses and 5198 workers to evaluate factors associated with burnout and satisfaction with WLI, and compare nurses to workers in othe...

Background and purpose: To evaluate the ability of the Well-Being Index (WBI) to stratify distress and well-being (high quality of life [QOL]) in nurse practitioners and physician assistants (NPs and PAs) and identify those whose degree of distress place them at an increased risk for medical error or turnover. Methods: A national sample of NPs a...

The current health care practice environment has resulted in a crescendo of burnout among physicians, nurses, and advanced practice providers. Burnout among health care professionals is primarily caused by organizational factors rather than problems with personal resilience. Four major drivers motivate health care leaders to build well-being progra...

Background: Studies suggest there is a high prevalence of burnout and depression among U.S. nurses. Objectives: To gauge the capability of the Well-Being Index (WBI) to stratify nurse distress (e.g., low quality of life [QOL], extreme fatigue, burnout, recent suicidal ideation) and well-being (high quality of life), and detect those whose level...

Purpose: The programmed death-1 (PD-1) pathway is crucial in tumor immunity evasion and its blockade has emerged as an effective anti-cancer immunotherapy. PD-1 and PD-L1 expression has not been thoroughly examined in chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and their associated large B-cell Richter transformation (DLBCL-RT...

Objective: The objective of this study was to evaluate the performance of the Professional Fulfillment Index (PFI), a 16-item instrument to assess physicians' professional fulfillment and burnout, designed for sensitivity to change attributable to interventions or other factors affecting physician well-being. Methods: A sample of 250 physicians...

Chronic lymphocytic leukemia (CLL) patients progressed early on ibrutinib often develop Richter transformation (RT) with a short survival of about 4 months. Preclinical studies suggest that programmed death 1 (PD-1) pathway is critical to inhibit immune surveillance in CLL. This phase 2 study was designed to test the efficacy and safety of pembroli...

CD49d is a surface integrin that is expressed on chronic lymphocytic leukaemia (CLL) cells, and strongly correlates with more aggressive disease. Given its association with cell-cell adhesion and leucocyte trafficking, we hypothesized that patients with high CD49d expression would experience a clinical course dominated by lymphadenopathy. CD49d exp...

Akt is a downstream target of B cell receptor signaling and is a central regulator of CLL cell survival. We aim to investigate the safety and efficacy of the Akt inhibitor MK-2206 in combination with bendamustine and rituximab (BR) in relapsed and/or refractory CLL in a phase I/II study. A standard phase I design was used with cohorts of three plus...

(Abstracted from Lancet 2016;388:2272–2281) Physician burnout, as documented in national studies, has a prevalence rate exceeding 50% in both physicians in training and practicing physicians. It negatively affects patient care, professionalism, physicians’ own care, and safety.

Burnout is a pervasive threat to medicine and as a specialty, we need to take a hard look at why Emergency Medicine (EM) repeatedly demonstrates the highest rates of burnout in the house of Medicine. More importantly, we need to correct for this. More than two-thirds of Emergency Physicians surveyed are reporting burnout[1]. This threatens our fron...

The US health care delivery system and the field of medicine have experienced tremendous change over the last decade. At the system level, narrowing of insurance networks, employed physicians, and financial pressures have resulted in greater expectations regarding productivity, increased workload, and reduced physician autonomy. Physicians also hav...

Blood Cancer Journal is a peer-reviewed, open access online journal publishing pre-clinical and clinical work in the field of hematology with ramifications into translational biology research down to new therapies

Clinician burnout reduces the capacity for providers and health systems to deliver timely, high quality, patient-centered care and increases the risk that clinicians will leave practice. This is especially problematic in hospice and palliative care: patients are often frail, elderly, vulnerable and complex; access to care is often outstripped by ne...

Objective: To study prevalence of and factors that contribute to burnout, career satisfaction, and well-being in US neurologists. Methods: A total of 4,127 US American Academy of Neurology member neurologists who had finished training were surveyed using validated measures of burnout, career satisfaction, and well-being from January 19 to March...

Purpose: Although burnout and low quality of life (QOL) are common among medical students, little remains known about personal fitness habits of medical students that may promote well-being. Method: In 2012 the authors conducted a cross-sectional study of U.S. medical students to explore relationships between burnout, QOL, and compliance with Ce...

http://www.bloodjournal.org/content/128/22/4376

Background: It is well established that the incidence of skin cancers in patients with CLL are significantly elevated compared to age- and sex- matched controls. However, little is known about the characteristics of CLL patients who develop skin cancer. Herein, we evaluate the associations of CLL clinical and prognostic characteristics, along with...

Although preliminary data suggests that ibrutinib may increase risk of atrial fibrillation (AF), the incidence of AF in a general cohort of chronic lymphocytic leukemia (CLL) patients is unknown. We evaluated the prevalence of AF at CLL diagnosis and incidence of AF during follow-up in 2444 patients with newly diagnosed CLL. A prior history of AF w...

Bevacizumab is a monoclonal antibody targeting vascular endothelial growth factor (VEGF) with in vitro pro-apoptotic and antiangiogenic effects on chronic lymphocytic leukemia (CLL) cells. As monotherapy in patients with CLL, it has no clinical activity. Here we report the results of an open-label, randomized phase II trial comparing the combinatio...

Due to Cytochrome P450 3A (CYP3A) metabolism, clinical trials of ibrutinib-treated chronic lymphocytic leukemia (CLL) patients prohibited concurrent medications metabolized by CYP3A. We evaluated concomitant medication use in 118 ibrutinib-treated CLL patients outside the context of clinical trials. Seventy-five (64%) patients were on medications t...

Chronic lymphocytic leukemia (CLL) mainly affects older people: the median age at diagnosis is above seventy years. Elderly patients with CLL are heterogeneous with regard both to the biology of their disease and aging. Following the diagnosis of CLL in an elderly individual, careful risk assessment is essential when treatment options are evaluated...

These are challenging times for health care executives. The health care field is experiencing unprecedented changes that threaten the survival of many health care organizations. To successfully navigate these challenges, health care executives need committed and productive physicians working in collaboration with organization leaders. Unfortunately...

Among all adults, creatinine clearance decreases with age, with the majority of individuals older than 75 years having a glomerular filtration rate less than 60 mL/min.[1][1] In the general population, creatinine clearance levels are found to be positively associated with life expectancy. Thus