Moral Distress and Moral Injury Among Attending Neurosurgeons: A National Survey

Mackel, Charles E.; Alterman, Ron L.; Buss, Mary K.; Reynolds, Renée; Fox, W. Christopher; Spiotta, Alejandro M; Davis, Roger B.; Stippler, Martina

doi:10.1227/neu.0000000000001921

Cited by 11 publications

(4 citation statements)

References 45 publications

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“…In 19 articles, individual factors were considered in relation to their association with moral distress among surgeons (2)(3)(4)(5)(6)8,10,25,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). In some instances, this was in connection to demographic characteristics such as gender (2,8,30,31), years in practice (2,29,(31)(32)(33)36), and the impact of being in a leadership or supervisory position (30).…”

Section: Individualmentioning

confidence: 99%

“…Interpersonal factors were also explored in relation to the moral distress among surgeons (3,(5)(6)(7)(8)(9)(25)(26)(27)(31)(32)(33)(34)(35)(36)(37)(38)(39). In some instances, these interpersonal factors arose in connection to the care provided, such as having unclear or inconsistent goals of care (7,25,34,37), discordance among and between teams or families (3,5,8,26,38), disruptions to the doctorpatient relationship (32), providing life prolonging intervention for terminally ill patients (3,(6)(7)(8)(9)25,33,34,37,39) and pressure from others to drive care (7,8,25,26,33,34,37). In studies assessing surgeons, interpersonal factors' impact on moral distress appear to differ based on surgeon roles.…”

Section: Interpersonalmentioning

confidence: 99%

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To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons

Millis¹,

Vitous²,

Ferguson³

et al. 2023

Ann Palliat Med

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Background: There is increasing concern about the prevalence and impact of moral distress among healthcare workers. While this body of literature is growing, research specifically examining sources of moral distress among surgeons remains sparse. The unique attributes of the surgeon-patient relationship and the context of surgery may expose surgeons to sources of distress that are distinct from other healthcare providers. To date, a summative assessment of moral distress among surgeons does not exist. Methods: We conducted a scoping review of studies focused on moral distress among surgeons. Using guidelines established by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), relevant articles were identified in EBSCOhost PsycINFO, Elsevier EMBASE, Ovid MEDLINE, and Wiley Cochrane Central Register of Controlled Trials Library from January 1, 2009 to September 29, 2022. Detailed data abstraction was performed on a predetermined instrument and compared across studies.A mixed-methods meta-synthesis was employed for data analysis, and both deductive and inductive methodology was used in our thematic analysis.Results: A total of 1,003 abstracts were screened, and 26 articles (19 quantitative and 7 qualitative) were included for full-text review. Of these, 10 focused only on surgeons. Our analysis revealed numerous definitions of moral distress and 25 instruments used to understand the sources of distress. Moral distress among surgeons is complex and influenced by factors at multiple levels, The most frequent sources originate at the individual and interpersonal levels. However, the environmental, community and policy levels also noted sources of distress. Conclusions:The reviewed articles identified several common themes and sources of moral distress among surgeons. We also found that research investigating sources of moral distress among surgeons is relatively sparse and confounded by various definitions of moral distress, multiple measurement tools, and frequently conflated terms of moral distress, moral injury, and burnout. This summative assessment presents a model of moral distress delineating these distinct terms, which may be applied to other professions at risk for moral distress.

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Section: Individualmentioning

confidence: 99%

Section: Interpersonalmentioning

confidence: 99%

To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons

Millis¹,

Vitous²,

Ferguson³

et al. 2023

Ann Palliat Med

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“…Articles on ethics and conflicts of interest (COI) ranged from general discussions of ethics in neurosurgery to very specific ethical questions. 152-178 Furr et al and Suskin and Giordano reviewed the topic of human head transplantation. 173,175 Four authors discussed informed consent.…”

Section: Resultsmentioning

confidence: 99%

A Scoping Review of Professionalism in Neurosurgery

Mangham,

Parikh,

Motiwala

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: The Accreditation Council for Graduate Medical Education's Milestones provides a foundation for professionalism in residency training. Specific professionalism concepts from neurosurgery could augment and expand milestones for the specialty. We reviewed the current literature and identified professionalism concepts within the context of neurosurgical practice and training. METHODS: We used a scoping review methodology to search PubMed/MEDLINE and Scopus and identify English-language articles with the search terms “professionalism” and “neurosurgery.” We excluded articles that were not in English, not relevant to professionalism within neurosurgery, or could not be accessed. Non–peer-reviewed and qualitative publications, such as commentaries, were included in the review. RESULTS: A total of 193 articles were included in the review. We identified 6 professionalism themes among these results: professional identity (n = 53), burnout and wellness (n = 51), professional development (n = 34), ethics and conflicts of interest (n = 27), diversity and gender (n = 19), and misconduct (n = 9). CONCLUSION: These 6 concepts illustrate concerns that neurosurgeons have concerning professionalism. Diversity and gender, professional identity, and misconduct are not specifically addressed in the Accreditation Council for Graduate Medical Education's Milestones. This review could be used to aid the development of organizational policy statements on professionalism.

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“…The physicians´ age, gender and working position (GP or hospital physicians) significantly impacted their responses. Other studies also show that being female, younger, and their speciality are predictors of higher moral distress among health care providers [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

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

Miljeteig,

Førde,

Rø

et al. 2023

Preprint

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BackgroundThe scarcity of resources represents ethical challenges and involves moral distress for health professionals. There are no longitudinal studies of moral distress among representative samples of physicians.MethodSurveys of the Norwegian Physician Panel (NPP) compared the extent of moral distress in 2004 and 2021. Descriptive statistics and regression analysis were used in the study.ResultsResponse rates were 67% (1004/1499) in 2004 and 70% (1639/2316) in 2021. That patient care is deprived due to time constraints is the most severe dimension of moral distress among physicians, and it has increased comparing 2021 with 2004 (68.3% in 2004 to 75.1% in 2021 reported “somewhat” or “very morally distressing”). Moral distress also increased concerning patients who “cry the loudest” get better and faster treatment than others. Moral distress was reduced on statements about long waiting times, treatment not provided due to economic limitations, deprioritisation of older patients, and acting against one’s conscience. Women reported higher moral distress than men in both years, and there were significant gender differences for six statements in 2021 and one in 2004. Though not consistently, the physicians’ age and workplace influenced the reported moral distress.ConclusionIn both years, moral distress among physicians related to scarcity of or unfair distribution of resources was high. Moral distress associated with resource scarcity and acting against one’s conscience decreased, which might indicate improvements in the healthcare system. On the other hand, it might suggest that physicians have reduced their ideals or expectations or are morally fatigued.

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Moral Distress and Moral Injury Among Attending Neurosurgeons: A National Survey

Cited by 11 publications

References 45 publications

To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons

To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons

A Scoping Review of Professionalism in Neurosurgery

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

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