Update in Hospital Palliative Care: Symptom Management, Communication, Caregiver Outcomes, and Moral Distress

Havyer, Rachel D.; Pomerantz, Daniel; Jayes, Robert L.; Harris, Patricia F.; Harman, Stephanie; Ansari, Aziz

doi:10.12788/jhm.2895

Cited by 2 publications

(4 citation statements)

References 12 publications

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“…12,13 In particular, Hayver et al identify that the provision of futile treatments contributes to moral distress in physician trainees. 14 The results of the present Australian study also reflect the ethical issues associated with physician emotional and moral distress reported for MET teams in Italy. 15 Conflict with ward physicians and dealing with families unprepared for EOLC were the most commonly Benefit to the patient 'Providing comfort to the patient and their family' 'Seeing the family and patient relieved that dignity and symptom alleviation are now the main priority' Supporting staff 'Support for junior covering staff reduces their emotional distress' 'Seeing ward staff relieved that their advocacy for the patient is being heard' Facilitating goals of care discussions 'Ability to facilitate and direct end of life care decision making to produce the best outcome for the patient' What are the three most challenging aspects of managing an end of life care MET call?…”

Section: Comparison With Previous Studiessupporting

confidence: 72%

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Intensive care unit trainee perception of end‐of‐life care provided during medical emergency team activation events

Rotherham

Jones

Presneill

2022

Internal Medicine Journal

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Background Hospital medical emergency team (MET) activation events involving end‐of‐life care (EOLC) are common. The issues faced by medical staff attending these events are incompletely described. Aims The purpose of this study was to measure the perceptions of Victorian hospital medical staff, training in the speciality of intensive care, about multiple aspects of EOLC MET calls. We sought to determine the overall extent of formal training in MET and EOLC and assess the domains of self‐perceived confidence, barriers to communication, frequency of clinician agreement and trainee distress. Methods We conducted an anonymous, voluntary, Internet‐based survey of registered trainees of the College of Intensive Care Medicine of Australia and New Zealand in May 2019. The participants eligible were those trainees working in an adult intensive care unit in Victoria, Australia, during the study period. The main outcome measures were self‐reported levels of confidence, barriers to communication, frequency of conflict and distress, senior support, supervision and access to training. Results Of 124 trainees surveyed, 75 (60%) responded. Overall, 78% of respondents felt confident to manage EOLC MET calls, but the frequently reported barriers to effective patient/next of kin communication included: (i) lack of private meeting rooms; (ii) resource and time constraints; and (iii) lack of patient and family availability during a MET call to discuss medical treatment limitations. Two‐thirds of respondents reported emotional distress at least occasionally, this being frequent in one in five. Most (68%) trainees experienced conflict with other medical teams at least occasionally. Factors associated with experiencing distress at least occasionally include greater trainee age, patients' being unable to participate in discussion due to illness, resource and time constraints and negative encounters with other medical teams. Conclusions Victorian intensive care trainees were confident managing EOLC MET activation events. However, distress was reported commonly and strategies are required to address the areas of concern.

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Section: Comparison With Previous Studiessupporting

confidence: 72%

“…In particular, Hayver et al . identify that the provision of futile treatments contributes to moral distress in physician trainees 14 …”

Section: Discussionmentioning

confidence: 99%

Intensive care unit trainee perception of end‐of‐life care provided during medical emergency team activation events

Rotherham

Jones

Presneill

2022

Internal Medicine Journal

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“…Contextual factors such as the employ of perceived futile care,2 97 99 100 108 115 116 120 121 130 131 134 157 161 162 167 171 177–179 resource constraints leading to prioritisation of care between patients,4 85 91 97 99 100 107 108 114 116 117 121 132 135–137 140 143 144 164 166 167 180–185 institutional rules, policies and organisational pressures that prevent physicians from providing appropriate patient care,4 85 94 99 113 114 120 124 140 147 150 151 153 166 168 175 177 180 185 186 and the disconnect between perceived ethical practice and delivered clinical practice predispose to MD 97 109 112 152 160 187…”

Section: Resultsmentioning

confidence: 99%

“…Indeed this SSR in SEBA reveals that physicians also include contextual, practice, environmental, cultural, community and institutional factors, resource limitations and allocations, quality of care and ethical dilemmas2 33 108 117 118 125 132 138 143 148 180 186 and personal factors including feelings of powerlessness and ‘attacks’ on their integrity,89 99 106 113 personal values,116 professional codes172 and existential beliefs105 139 166 171 as situational constructs that shape their personal constructs within their rings of personhood 3 38. Personal factors including gender, specialty, personality traits, principles, values, beliefs, experiences, circumstances and the availability of support mechanisms psychoemotional states, familial issues, and sociocultural factors also influences the perceptions and responses to MD 2 6–11 97 99 100 108 115 116 120 121 130 131 134 157 161 162 167 171 177–179. This combination of personal and situational constructs may explain the individual variations in the nature, intensity, duration and onset of anger, frustration, sadness, depression and or guilt1 89 90 94 97 104–107 113 115 119 120 122 123 136 137 143 151 154 157 160 164 168 173 188 and the presence of ‘distress’ even when the ‘right’ action is taken2 85 89 94 98 105 116 118 119 124 129 133 140 141 146 151 156 157 161 164 165 167 172 177 179 201 202 among reports of MD.…”

Section: Discussionmentioning

confidence: 99%

Systematic scoping review on moral distress among physicians

et al. 2022

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BackgroundConcepts of moral distress (MD) among physicians have evolved and extend beyond the notion of psychological distress caused by being in a situation in which one is constrained from acting on what one knows to be right. With many accounts involving complex personal, professional, legal, ethical and moral issues, we propose a review of current understanding of MD among physicians.MethodsA systematic evidence-based approach guided systematic scoping review is proposed to map the current concepts of MD among physicians published in PubMed, Embase, PsycINFO, Web of Science, SCOPUS, ERIC and Google Scholar databases. Concurrent and independent thematic and direct content analysis (split approach) was conducted on included articles to enhance the reliability and transparency of the process. The themes and categories identified were combined using the jigsaw perspective to create domains that form the framework of the discussion that follows.ResultsA total of 30 156 abstracts were identified, 2473 full-text articles were reviewed and 128 articles were included. The five domains identified were as follows: (1) current concepts, (2) risk factors, (3) impact, (4) tools and (5) interventions.ConclusionsInitial reviews suggest that MD involves conflicts within a physician’s personal beliefs, values and principles (personal constructs) caused by personal, ethical, moral, contextual, professional and sociocultural factors. How these experiences are processed and reflected on and then integrated into the physician’s personal constructs impacts their self-concepts of personhood and identity and can result in MD. The ring theory of personhood facilitates an appreciation of how new experiences create dissonance and resonance within personal constructs. These insights allow the forwarding of a new broader concept of MD and a personalised approach to assessing and treating MD. While further studies are required to test these findings, they offer a personalised means of supporting a physician’s MD and preventing burn-out.

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Update in Hospital Palliative Care: Symptom Management, Communication, Caregiver Outcomes, and Moral Distress

Abstract: Recent research provides important guidance for clinicians caring for hospitalized patients with serious illnesses, including symptom management, ACP, moral distress, and outcomes of critical illness.

Cited by 2 publications

References 12 publications

Intensive care unit trainee perception of end‐of‐life care provided during medical emergency team activation events

Intensive care unit trainee perception of end‐of‐life care provided during medical emergency team activation events

Systematic scoping review on moral distress among physicians

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