Moral distress in end-of-life decisions: A qualitative study of intensive care physicians

Ledger, Una St; Reid, Joanne; Begley, Ann; Dodek, Peter; McAuley, Daniel F.; Prior, Lindsay; Blackwood, Bronagh

doi:10.1016/j.jcrc.2020.12.019

Cited by 48 publications

(37 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Working with others was impacted by the FOF subscale Fear of Devaluing One's Self-Estimate, which is consistent to the literature suggesting that some professionals are reluctant to engage and work with palliative care teams in the care of their patients due to the fear that this indicates the failure of their treatment [24,52]. Given there were not more relationships shown with other FIF subscales might indicate that the 'working with others' questions on the SEPC scale do not accurately measure a person's likelihood to engage a palliative care team, but rather their con dence if they happen to work with other teams.…”

Section: Discussionsupporting

confidence: 85%

“…Feelings of failure are elicited in clinicians when patients reject treatment, when negotiations fail, or when a patient's body no longer responds to treatment. Failure has been found to be shaped by social and cultural expectations of responsibility; coming both from clinician, peers in medical teams, and patients receiving support [16, 24,36,[50][51][52]. There may be a cyclical effect with FOF in healthcare settings; avoiding patient deaths and EOL discourse may further impede con dence and comfortableness within this area.…”

Section: Fear Of Failure: a Theoretical Contextmentioning

confidence: 99%

See 1 more Smart Citation

The Effect of Fear of Failure on Confidence in, and Comfortableness With, the Delivery of End-of-life Care

Latham

Butchard

Mason

2022

Preprint

View full text Add to dashboard Cite

ObjectiveTo investigate whether fear of failure (FOF) influences a clinician’s perception of their confidence and comfortableness with the delivery of end of life (EOL) care, controlling for gender, role, years of experience, and number of EOL conversations. DesignCross-sectional questionnaire study.Setting Two large NHS hospital trusts in the UK, and national UK professional networks.Participants105 doctors and 104 specialist nurses across 20 hospital specialities. Main outcome measuresThe Performance Failure Appraisal Inventory, the Self-Efficacy in Palliative Care scale, the Thanatophobia Scale. Analysis A two-step multiple regression.ResultsThe study validated the use of the PFAI and its subscales within a novel population group of medical professionals. No. of EOL conversations, gender, and role impacted confidence and comfortableness with EOL care. Fearing loss of interest negatively impacted a clinician’s confidence in communicating with patients. Fear of devaluing one’s self-estimate negatively impacted confidence in decision making, working with others, and total self-efficacy.ConclusionThree aspects of FOF negatively impacted both doctors and nurses delivery of EOL care. Practical ImplicationsFurther study should look at how FOF develops, sustaining factors, and other areas of clinical practice that FOF impacts, drawing also from FOF research outside the field of medicine. Techniques developed to manage FOF in other populations can now be investigated with a medical population.

show abstract

Section: Discussionsupporting

confidence: 85%

Section: Fear Of Failure: a Theoretical Contextmentioning

confidence: 99%

The Effect of Fear of Failure on Confidence in, and Comfortableness With, the Delivery of End-of-life Care

Latham

Butchard

Mason

2022

Preprint

View full text Add to dashboard Cite

show abstract

“…St Ledger et al conducted a qualitative study to assess moral distress following end-of-life decisions perceived by the physicians and nurses in the neonatal intensive care units in Belfast. They reported moral distress to be significant ( 29 ). Dodek et al, in a study from Vancouver, identified that the ICU nurses face critical conditions requiring important decisions, and these situations make the experience of moral distress among them more likely.…”

Section: Discussionmentioning

confidence: 99%

Moral distress among Iranian neonatal intensive care units’ health care providers: a multi-center cross sectional study

Tajalli¹,

Rostamli²,

Dezvaree³

et al. 2021

jmehm

View full text Add to dashboard Cite

Due to the unique nature of the neonatal intensive care unit (NICU) and its moral distress, this study aimed to investigate moral distress in the NICU. This cross-sectional study was conducted on 234 physicians and nurses working in the neonatal wards of eight hospitals. The Corley’s Moral Distress Scale was used to collect data. Findings showed that 25 of the participants were physicians and 209 were nurses. The intensity and frequency of distress among physicians and nurses were assessed as moderate. The mean intensity and frequency of moral distress among nurses and physicians were 48.3%, 41.5% and 46.46%, 15.62% respectively. The results showed that the mean intensity and frequency of distress were higher, however not significantly, among nurses. The intensity and frequency of moral distress had a statistically significant and direct correlation with the intention to leave and the number of staff in each working shift among the nurses. Moral distress in the NICU practitioners was moderate, so addressing this issue and trying to alleviate it was important. Identifying the causes behind moral distress can help adopt appropriate measures to prevent and reduce them.

show abstract

“…In mental health care, RNs experienced moral distress when they had to manage care for people suffering greatly and needing seclusion or coercion but where resources were lacking [ 11 ]. Physicians have described enduring moral distress when faced with too long waiting lists [ 22 ], crucial end-of life decisions in intensive care, and in the tension between ensuring a good death and saving life [ 23 ]. Hospital social workers experienced moral distress when patients were not provided with an adequate service.…”

Section: Introductionmentioning

confidence: 99%

The Swedish translation and cultural adaptation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP)

Grönlund

Brännström

2021

BMC Med Ethics

View full text Add to dashboard Cite

Background Moral distress has been described as an emotionally draining condition caused by being prevented from providing care according to one’s convictions. Studies have described the impact of moral distress on healthcare professionals, their situations and experiences. The Measure of Moral Distress for Healthcare Professionals (MMD-HP) is a questionnaire that measures moral distress experienced by healthcare professionals at three levels: patient, system and team. The aim of this project was to translate and make a cultural adaption of the MMD -HP to the Swedish context. Methods The questionnaire comprises 27 items, rated according to frequency and intensity on a five-point Likert scale (0–4). The procedure for translating MMD-HP followed WHO guidelines (2020). These entailed a forward translation from English to Swedish, a back translation, expert panel validation, pretesting and cognitive face-to-face interviews with 10 healthcare professionals from various professions and healthcare contexts. Results The Swedish version of MMD-HP corresponds essentially to the concept of the original version. Parts of some items’ had to be adjusted or removed in order to make the item relevant and comprehensible in a Swedish context. Overall, the cognitive interviewees recognized the content of the items which generally seemed relevant and comprehensible. Conclusion The Swedish version of MMD-HP could be a useful tool for measuring moral distress among healthcare professionals in a Swedish healthcare context.

show abstract

Moral distress in end-of-life decisions: A qualitative study of intensive care physicians

Cited by 48 publications

References 34 publications

The Effect of Fear of Failure on Confidence in, and Comfortableness With, the Delivery of End-of-life Care

The Effect of Fear of Failure on Confidence in, and Comfortableness With, the Delivery of End-of-life Care

Moral distress among Iranian neonatal intensive care units’ health care providers: a multi-center cross sectional study

The Swedish translation and cultural adaptation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP)

Contact Info

Product

Resources

About