A national study of moral distress among U.S. internal medicine physicians during the COVID-19 pandemic

Abstract

Background There have been no studies to date of moral distress during the COVID-19 pandemic in national samples of U.S. health workers. The purpose of this study was to determine, in a national sample of internal medicine physicians (internists) in the U.S.: 1) the intensity of moral distress; 2) the predictors of moral distress; 3) the outcomes of moral distress. Methods We conducted a national survey with an online panel of internists, representative of the membership of the American College of Physicians, the largest specialty organization of physicians in the United States, between September 21 and October 8, 2020. Moral distress was measured with the Moral Distress Thermometer, a one-item scale with a range of 0 (“none”) to 10 (“worst possible”). Outcomes were measured with short screening scales. Results The response rate was 37.8% (N = 810). Moral distress intensity was low (mean score = 2.4, 95% CI, 2.2–2.6); however, 13.3% (95% CI, 12.1% - 14.5%) had a moral distress score greater than or equal to 6 (“distressing”). In multiple linear regression models, perceived risk of death if infected with COVID-19 was the strongest predictor of higher moral distress (β (standardized regression coefficient) = 0.26, p < .001), and higher perceived organizational support (respondent belief that their health organization valued them) was most strongly associated with lower moral distress (β = -0.22, p < .001). Controlling for other factors, high levels of moral distress, but not low levels, were strongly associated (adjusted odds ratios 3.0 to 11.5) with screening positive for anxiety, depression, posttraumatic stress disorder, burnout, and intention to leave patient care. Conclusions The intensity of moral distress among U.S. internists was low overall. However, the 13% with high levels of moral distress had very high odds of adverse mental health outcomes. Organizational support may lower moral distress and thereby prevent adverse mental health outcomes.

Resource conflicts leading to moral distress: A longitudinal study among physicians in Norway

“…This is higher than for other surveys of the medical profession [22]. The sample also represents the population of practising physicians in Norway in key aspects like gender, age and workplace [23]. This provides a reasonable basis for generalisation but does not entirely rule out the possibility of nonresponse bias.…”

“…To learn how these changes impact moral distress over time, longitudinal studies are needed [22]. Few longitudinal studies of moral distress exist, and the available ones are of short duration (weeks or months) [23][24][25]. The Norwegian Physician Panel makes it possible to compare the same physicians over time.…”

Moral distress among clinicians working in US safety net practices during the COVID-19 pandemic: a mixed methods study

“…Various approaches have been suggested to reduce moral distress among clinicians. Managers of outpatient practices should understand what moral distress means for clinicians and its importance to them, create supportive work environments, create ways for clinicians and staff to learn and talk about moral distress and safely raise morally distressing issues, identify and address any ongoing sources of moral distress, and provide clinicians with needed psychological support and time away from work 10 12 86 90 91. Clinicians should be involved in operational decisions made during challenging times—indeed, all times—so that decisions can be informed by their perspectives and clinicians can better understand the choices available to their practices and reasoning behind the decisions made that affect them, their colleagues and their patients.…”

Psychological distress among healthcare providers in oncology during the COVID-19 pandemic in Japan: The mediating role of moral distress and resilience

“…It was designed as a screening tool targeted toward nurses in a hospital setting and has good convergent and discriminant validity ( Wocial and Weaver, 2013 ). It has been used to measure moral distress in HCPs ( Mehlis et al, 2018 ; Sonis et al, 2022 ). The Japanese translation of the Moral Distress Thermometer was handled by a native English-speaking researcher who is fluent in Japanese and a Japanese-speaking researcher who is fluent in English.…”

“…HCPs in oncology might be prone to moral distress when deciding between cancer care and infection control. Moral distress is defined as the discomfort felt when a person, institution, or situation prevents a HCP from doing what he or she believe is morally right in health care ( Sonis et al, 2022 ). Studies of moral distress among HCPs related to the COVID-19 pandemic have shown associations between moral distress and mental health issues, including anxiety, depression and post-traumatic stress disorder (PTSD; Norman et al, 2021 ; Petrisor et al, 2021 ; Schneider et al, 2021 ; Lake et al, 2022 ).…”