Moral Distress with Obstacles to Hepatitis C Treatment: A Council of Academic Family Medicine Educational Research Alliance (CERA) Study of Family Medicine Program Directors

Abstract

Background and Objective: To determine whether family medicine program directors (PDs) experienced moral distress due to obstacles to Hepatitis C virus (HCV) treatment, and to explore whether they found those obstacles to be unethical.Design: An omnibus survey by the Council of Academic Family Medicine's Educational Research Alliance was administered to 452 and completed by 273 US-based PDs. The survey gauged attitudes and opinions regarding ethical dilemmas in patient access to HCV treatment.Results: Most of the respondents were male. Sixty-four percent of respondents believed that treatment should be an option for all patients regardless of cost. Forty-one percent believed that it was unethical to deny treatment based on past or current substance use, and 38% believed treatment should be offered to patients who were substance abusers. Moral distress was reported by 61% (score >3) of participants when they were unable to offer treatment to patients due to the patient's failure to meet eligibility criteria. In addition, PDs reporting moderate-to-high levels of moral distress were also likely to report the following opinions: 1) treatment should be offered regardless of cost, 2) it is unethical to deny treatment based on past behavior, 3) substance abusers should be offered treatment, 4) it is unethical for medicine to be prohibitively expensive, and 5) Medicaid policy that limits treatment will worsen racial and ethnic disparities.Conclusions: Currently, important ethical dilemmas exist in the access and delivery of HCV therapy. Although a diversity of opinions is noted, a significant proportion of PDs are concerned about patients' inability to avail equitable care and experience distress. In some cases, this moral distress is in response to, and in conflict with, current guidelines. (J Am Board Fam Med 2018;31:286 -291.)

Family physicians’ moral distress when caring for patients experiencing social inequities: a critical narrative inquiry in primary care

“…The stories of 20 family physicians who care for patients with medical needs related to social inequity highlights how moral distress can be grounded in broader systemic and structural factors. The study findings, to our knowledge, are some of the first to illustrate the moral distress experiences of family physicians, particularly those working with patients experiencing inequities, which builds upon the small body of moral distress scholarship in the primary care literature (63)(64)(65)(66)(67)(68)(69). Our participants' moral distress was associated with remuneration structures and workload demands, and was exacerbated by a lack of social resources such as housing, sufficient and comprehensive mental health and addictions services, which resulted in strict limitations on their ability to provide comprehensive care.…”

Gendered and racial experiences of moral distress: A scoping review

“…Women or females were highly represented in studies involving nurses as participants while men or males were more likely to be the bulk of participants in studies involving physicians and administrative leadership. In one study, about 93% of 119 participating nurses were female (DeKeyser Ganz & Berkovitz, 2012); in another, 64% of participating family medicine program directors were male (Simha et al., 2018) and in another study, 87% of participating physicians were male (Dodek et al., 2016). Such representation is generally reflective of the gender makeup of these professions.…”