Evaluation of biofeedback components for the management of acute stress in healthcare
Kennedy-Metz, Lauren Rose
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Medical error is the third leading cause of death in the United States, with surgery being a critical area for improvement. Of particular interest for this dissertation is understanding and mitigating the impact of acute stress experienced by surgeons. Previous research demonstrates the detrimental effects mismanaged acute stress can have on cognitive performance integral in optimal surgical practice. Biofeedback consists of objectively monitoring signs of stress, presenting physicians with their own physiological output in real time. Introducing appropriate, targeted coping mechanisms when they are most needed may facilitate behavioral adjustments in the face of acute stress. The goal of this dissertation research was to evaluate the potential benefit of biofeedback and coping instructions, measured by reduced perceived and physiological stress, and improved task performance. In the first study, college students participated in a first-person shooter videogame while receiving visual coping instructions. Instructions that were presented at moments of elevated stress improved downstream physiology compared to randomly administered instruction, and the presence of coping instructions was more beneficial than their absence at highly stressful times. In the second study, I adapted and validated a computer-based task to focus on components of workload experienced by physicians. This study yielded one high-stress and one-low stress version of a more demographic-appropriate task. In the final study, medical students and residents completed this task. The independent variables tested included a visual biofeedback interface, intermittent auditory coping instructions, and/or brief training on stress management and emotional intelligence. Results from this study showed that despite high cognitive workload experienced by participants receiving both biofeedback and coping instructions, performance across stress levels was indistinguishable, and physiological indicators of stress immediately following discrete coping instructions was reflective of decreased stress. Taken together, the results of these studies validate the generation of a new lab-based task to induce stress among healthcare providers, and the physiological and performance benefits associated with physiologically-based coping instructions. Future work should investigate how these concepts can be tailored towards surgical workflow with feedback modality in mind, extended to teams, and/or scaled up to higher levels of fidelity to better capture the work environment.
General Audience Abstract
Medical error is the third leading causing of death in the United States, with surgery being a critical area for improvement. Many medical errors are preventable, and previous research has shown that inappropriately managed acute stress is responsible for many errors. Biofeedback is one way to externalize stress states, enabling individuals to monitor their own stress, even as it is changing. With rapid advancement in technological functionality, sensors hold promise not only for personal body data, but also active interventions such as biofeedback. Biofeedback is the process of actively monitoring physiology on an external device, and updating behaviors based on that physiology. Its role as a stress management tool is growing. Commercially available sensor devices are widespread, and are generating and archiving thousands of data points every day. Rather than simply archiving this data, we can use sensor technology to inform us of our current physiological and cognitive states in real time, and use that information to alter our response to stressful stimuli to achieve more favorable outcomes. This concept can be applied specifically to address how to cope when experiencing high levels of stress. For individuals working in high-stakes environments on a daily basis, such as surgeons, using physiological data to manage stress could have the added benefit of improving performance that might otherwise suffer due to mismanaged stress. The goal of this dissertation research is to explore the potential benefit of using biofeedback and specific coping strategies to reduce stress and improve performance among healthcare providers. This research consisted of different studies, all using experimental psychology approaches and all geared towards evaluating different conditions of either visual coping instructions, training on emotional intelligence concepts as they relate to coping under stress, visual biofeedback, and/or auditory coping instructions. The results of these studies validate the generation of a new lab-based task to induce stress among healthcare providers, support the benefit of introducing coping instructions in response to elevated physiological signs of stress, and support the need for future assessments.
- Doctoral Dissertations