Factors Associated with Physician Moral Distress Caring for Hospitalized Elderly Patients Needing a Surrogate Decision-maker: a Prospective Study

Wocial, Lucia D.; Slaven, James E.; Montz, Kianna; Monahan, Patrick O.; Hickman, Susan E.; Callahan, Christopher M.; Helft, Paul R.; Sachs, Greg A.; Inger, Lev; Burke, Emily S.; Torke, Alexia M.

doi:10.1007/s11606-020-05652-1

Cited by 13 publications

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References 39 publications

(45 reference statements)

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“…Based on our knowledge, this is the first study aimed to compare the levels of moral distress among different setting. Indeed, Wocial et al [ 34 ] analyzed the level of moral distress among physicians and found that they were less likely to experience moral distress when caring for patients living in a nursing home. However, Wocial et al [ 34 ] did not compare these findings with the hospital setting.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, Wocial et al [ 34 ] analyzed the level of moral distress among physicians and found that they were less likely to experience moral distress when caring for patients living in a nursing home. However, Wocial et al [ 34 ] did not compare these findings with the hospital setting. Indeed, in this study most of the sample working in community setting reported a low to moderate range of moral distress perceived, while most of the sample working in hospital settings reported a distressing to worst possible range.…”

Section: Discussionmentioning

confidence: 99%

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Levels of Moral Distress among Health Care Professionals Working in Hospital and Community Settings: A Cross Sectional Study

et al. 2021

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Moral distress is a concern for all healthcare professionals working in all care settings. Based on our knowledge, no studies explore the differences in levels of moral distress in hospital and community settings. This study aims to examine the level of moral distress among healthcare professional working in community or hospital settings and compare it by demographic and workplace characteristics. This is a cross-sectional study. All the professionals working in the hospitals or community settings involved received personal e-mail invitations to participate in the study. The Moral Distress Thermometer was used to measure moral distress among healthcare professionals. Before data collection, ethical approval was obtained from each setting where the participants were enrolled. The sample of this study is made up of 397 healthcare professionals: 53.65% of the sample works in hospital setting while 46.35% of the sample works in community setting. Moral distress was present in all professional groups. Findings have shown that nurses experienced level of moral distress higher than other healthcare professionals (mean: 4.91). There was a significant differences between moral distress among different professional categories (H(6) = 14.407; p < 0.05). The ETA Coefficient test showed significant variation between healthcare professionals working in community and in hospital settings. Specifically, healthcare professionals who work in hospital experienced a higher level of moral distress than those who work in community settings (means 4.92 vs. means 3.80). The results of this study confirm that it is imperative to develop educational programs to reduce moral distress even in those settings where the level perceived is low, in order to mitigate the moral residue and the crescendo effect.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Levels of Moral Distress among Health Care Professionals Working in Hospital and Community Settings: A Cross Sectional Study

et al. 2021

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“…First, at the fellowship level, fellows may benefit from a more robust education in primary palliative care skills [35]. Such training may include opportunities to improve communication skills, develop conflict resolution techniques, and learn about the Renal Physicians Association Shared Decision-Making guidelines on the initiation and withdrawal from dialysis [5,36,37]. These guidelines provide useful guidance to help clinicians manage many situations that frequently elicit moral distress [37].…”

Section: Discussionmentioning

confidence: 99%

Frequency and Severity of Moral Distress in Nephrology Fellows: A National Survey

et al. 2021

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Introduction: Moral distress is a negative affective response to a situation in which one is compelled to act in a way that conflicts with one’s values. Little is known about the workplace scenarios that elicit moral distress in nephrology fellows. Methods: We sent a moral distress survey to 148 nephrology fellowship directors with a request to forward it to their fellows. Using a 5-point (0–4) scale, fellows rated both the frequency (never to very frequently) and severity (not at all disturbing to very disturbing) of commonly encountered workplace scenarios. Ratings of ≥3 were used to define “frequent” and “moderate-to-severe” moral distress. Results: The survey was forwarded by 64 fellowship directors to 386 fellows, 142 of whom (37%) responded. Their mean age was 33 ± 3.6 years and 43% were female. The scenarios that most commonly elicited moderate to severe moral distress were initiating dialysis in situations that the fellow considered futile (77%), continuing dialysis in a hopelessly ill patient (81%) and carrying a high patient census (75%), and observing other providers giving overly optimistic descriptions of the benefits of dialysis (64%). Approximately 27% had considered quitting fellowship during training, including 9% at the time of survey completion. Conclusion: A substantial majority of nephrology trainees experienced moral distress of moderate to severe intensity, mainly related to the futile treatment of hopelessly ill patients. Efforts to reduce moral distress in trainees are required.

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“…Please see Supporting Information for a representation of how the instrument appeared to survey respondents. The Moral Distress Thermometer has good convergent and discriminant validity and has been used to measure moral distress in nurse and physician samples [ 4 ]. Unlike some instruments measuring moral distress [ 29 , 30 ], the Moral Distress Thermometer is not anchored to specific situations that cause moral distress [ 1 ].…”

Section: Methodsmentioning

confidence: 99%

“…Moral distress was initially reported among nurses, but it has been described in physicians and other health workers as well [ 3 , 4 ]. It is an important issue for health workers because it is associated with anxiety and guilt [ 5 ], depressive symptoms [ 6 ], and burnout and job attrition [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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

2022

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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.

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Factors Associated with Physician Moral Distress Caring for Hospitalized Elderly Patients Needing a Surrogate Decision-maker: a Prospective Study

Abstract: Author Contributions Dr. Torke had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Torke,

Cited by 13 publications

References 39 publications

Levels of Moral Distress among Health Care Professionals Working in Hospital and Community Settings: A Cross Sectional Study

Levels of Moral Distress among Health Care Professionals Working in Hospital and Community Settings: A Cross Sectional Study

Frequency and Severity of Moral Distress in Nephrology Fellows: A National Survey

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

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