Accepted Type
Oral
Code
OD2-2-2
Was this work accepted for CCME 2020?
no
Category
General Call (Workshop, Oral Presentation, Poster Presentation)
Type
Oral
Sub Type
Education Research
Will the presenter be a:
Other
Presenter Other
Mid-Career Faculty
Affiliation
Considered for Poster
no
Title
Moral Distress Among Practicing Canadian Critical Care Physicians: The Role of Moral Orientation
Length of Presentation
Background/Purpose
Moral distress is defined as a cognitive-emotional dissonance experienced when being compelled to witness or deliver patient care that does not meet personal moral standards. Moral distress is an important and under-recognized problem among medical trainees and practicing physicians. Moral distress has direct negative consequences for patient care (e.g., decreased compassion), individuals (e.g., burnout), and the healthcare system (workforce attrition).
Methods
We conducted a qualitative, interview-based study of practicing critical care physicians. We purposefully selected a sub-group of physicians who had agreed to be contacted after completing a national survey on moral distress. Our objective was to enrich our understanding of moral distress experiences and relationships between professional interactions, context, and moral distress. Phone interview audio-recordings were transcribed verbatim and analyzed using an inductive thematic analysis. We used thematic saturation, researcher triangulation, and reflexivity to ensure rigor.
Results
We interviewed 20 critical care physicians. Moral orientation (how individuals usually perceive and resolve moral dilemmas), combined with legal, societal, clinical, and team contexts, contributed to moral distress. Participants commonly described three moral orientations: a justice orientation, a relationship orientation, and a non-committal orientation. We described how individual susceptibility to moral distress depended on moral orientation, how individuals learn to manage moral dilemmas over time, how different moral stances led to conflicts within team, and how communication within teams was as important as communication with families to reduce moral distress.
Conclusion
Moral orientation is a key aspect of moral distress. Certain moral orientations, as well as divergent moral orientations among colleagues, create internal and external conflicts, and may represent promising targets of educational interventions to reduce moral distress.
Keyword 1
Moral distress
Keyword 2
Ethics
Keyword 3
End-of-life care
Level of Training
General
Abstract Themes
Physician & Medical Student Health and Well-being
Additional Theme (First choice)
Professionalism
Additional Theme (Second Choice)
Continuing Medical Education
Additional Theme (Third Choice)
Authors
Presenter
Dominique Piquette
Term 1
Yes
Term 2
Yes
Term 3
Yes
Term 4
Yes
Term 5
Yes
