Moral Distress Among Oncology Social Workers

Guan, Ting; Nelson, Krista; Otis‐Green, Shirley; Rayton, Makeeta; Schapmire, Tara; Wiener, Lori; Zebrack, Brad

doi:10.1200/op.21.00276

Cited by 14 publications

(9 citation statements)

References 28 publications

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“…[3][4][5][6][7][8] Despite the advances in our understanding of burnout among members of the oncology team, there remains a limited understanding of the impact of moral distress (MD) and its relationship to burnout. [9][10][11][12] MD is the result of barriers or constraints that prevent providers from carrying out what they believe to be ethically appropriate care. Barriers to carrying out what health care providers believe to be the right care can be related to patient-, team-, and institution-level constraints.…”

Section: Corresponding Author Original Contributionsmentioning

confidence: 99%

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Moral Distress, Organizational Climate, and the Risk of Burnout Among Physician Assistants in Oncology

Tetzlaff

Hylton²,

Ruth

et al. 2023

JCO Oncology Practice

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PURPOSE: Moral distress (MD) is the result of barriers or constraints that prevent providers from carrying out what they believe to be ethically appropriate care. This study was initiated to explore associations between MD, burnout, and the organizational climate (OC) for oncology physician assistants (PAs). METHODS: A national survey of oncology PAs was conducted to explore the associations between MD, OC, and burnout. The Nurse Practitioner-Primary Care OC Questionnaire was revised for oncology PAs to assess OC for PA practice. MD and burnout were assessed using the Measure of MD-Healthcare Professionals (MMD-HP) and the Maslach Burnout Inventory. RESULTS: One hundred forty-six oncology PAs are included in the analysis. PAs were mostly female (90%), White/Caucasian (84%), married/partnered (78%), and in medical oncology (73%), with mean age 41.0 years. The mean MMD-HP score for oncology PAs was 71.5 and there was no difference in MD scores on the basis of oncology subspecialty, practice setting, practice type, or hours worked per week. PAs currently considering leaving their position because of MD had significantly higher mean scores on the MMD-HP compared with those not considering leaving their position (108.2 v 64.8; P = .001). PAs with burnout also had significantly higher mean scores for MD compared with PAs without burnout (97.6 v 54.3; P < .001). A negative relationship between OC for PA practice and MD was only found for the PA-administration relations subscale, whereas all subscales were negatively associated with burnout. CONCLUSION: This study demonstrates that the risk of professional burnout increases significantly with increasing levels of MD. Additional research exploring the relationship between MD and burnout is needed.

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Section: Corresponding Author Original Contributionsmentioning

confidence: 99%

“…3-8 Despite the advances in our understanding of burnout among members of the oncology team, there remains a limited understanding of the impact of moral distress (MD) and its relationship to burnout. 9-12…”

Section: Introductionmentioning

confidence: 99%

Moral Distress, Organizational Climate, and the Risk of Burnout Among Physician Assistants in Oncology

Tetzlaff

Hylton²,

Ruth

et al. 2023

JCO Oncology Practice

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“…Studies investigating the relationship between MD and years of practice reported mixed results. Some studies recorded a higher level of MD in healthcare providers with more years of practice [ 6 , 19 , 20 ], as repeated exposure to MD experiences would increase the perception of distress. Other studies found that nurses lacking experience in dealing with ethically challenging situations at the beginning of their professional careers may be at greater risk of MD [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Moral Distress in Oncology: A Descriptive Study of Healthcare Professionals

Guariglia

Terrenato

Iacorossi

et al. 2023

IJERPH

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Background: The oncology setting is characterized by various complexities, and healthcare professionals may experience stressful conditions associated with ethical decisions during daily clinical practice. Moral distress (MD) is a condition of distress that is generated when an individual would like to take action in line with their ethical beliefs but in conflict with the healthcare facility’s customs and/or organization. This study aims to describe the MD of oncology health professionals in different care settings. Methods: Descriptive quantitative study was conducted in the Operating Units of the Istituti Fisioterapici Ospitalieri in Rome between January and March 2022. The investigated sample consisted of the medical and nursing staff on duty at the facility, who were given a questionnaire through a web survey. Besides a brief sociodemographic form, the MD Scale-Revised questionnaire was used for data collection. Results: The sample consisted of nurses (51%) and physicians (49%), predominantly working in surgeries (48%), and having 20–30 years of service (30%). MD was higher among healthcare professionals, in medicine than that ing in corporate organizations, surgeries, or outpatient clinics (p = 0.007). It was not related to the profession (p = 0.163), gender (p = 0.103), or years of service (p = 0.610). Conclusions: This paper outlines the prevalence of MD in care settings and describes its relationship with profession, gender, and seniority. There is no patient care without the care of health professionals: knowing and fighting MD improves the safety of the treatments provided and the quality perceived by patients.

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“…34,35 Research investments must be aimed towards generating sustainable means of care delivery in order to bolster long-term clinician wellbeing and mitigate distress peri- and post-pandemic, particularly in light of substantive evidence describing the burnout and moral suffering of healthcare workers - including palliative care and oncology clinicians - that long preceded COVID-19 and has been exacerbated by myriad sequelae of this public health emergency. 36-40…”

Section: Discussionmentioning

confidence: 99%

“It Took Away and Stripped a Part of Myself”: Clinician Distress and Recommendations for Future Telepalliative Care Delivery in the Cancer Context

Rosa

Lynch

Hadler

et al. 2022

Am J Hosp Palliat Care

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Background The COVID-19 pandemic has led to the rapid expansion of telehealth service delivery. We explored the experiences of a multidisciplinary palliative care team delivering telepalliative care for oncology inpatients during a 10-weeks COVID-19 surge in New York City. Methods/Participants We conducted semi-structured qualitative interviews with a targeted sample, employing a phenomenological approach with applied thematic text analysis. An interdisciplinary coding team iteratively coded data using a mix of a priori and inductive codes. Team members first independently reviewed each category, then met to reach consensus on recurring themes. The sample (n = 11) included a chaplain (n = 1), social worker (n = 1), pharmacist (n = 1), physicians (n = 3), physician assistant (n = 1), and nurse practitioners (n = 4). Results Participants described multidimensional clinician distress as a primary experience in delivering telepalliative care during the COVD-19 surge, characterized by competing loyalties (e.g., institutional obligations, ethical obligations to patients, resentment and distrust of leadership) and feelings of disempowerment (e.g., guilt in providing subpar support, decisional regret, loss of identity as a provider). Participants provided explicit recommendations to improve telepalliative care delivery for acute oncology inpatients in the future. Conclusion Palliative care clinicians experienced personal and professional distress providing inpatient telepalliative care during this COVID-19 surge. Clinician strain providing telehealth services must be explored further as the pandemic and utilization of telehealth evolves. Telepalliative care planning must include attention to clinician wellbeing to sustain the workforce and promote team cohesion, and a focus on infrastructure needed to deliver high-quality, holistic care for oncology patients and their families when in-person consultation is impossible.

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Moral Distress Among Oncology Social Workers

Cited by 14 publications

References 28 publications

Moral Distress, Organizational Climate, and the Risk of Burnout Among Physician Assistants in Oncology

Moral Distress, Organizational Climate, and the Risk of Burnout Among Physician Assistants in Oncology

Moral Distress in Oncology: A Descriptive Study of Healthcare Professionals

“It Took Away and Stripped a Part of Myself”: Clinician Distress and Recommendations for Future Telepalliative Care Delivery in the Cancer Context

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