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Abstract: PO1392

Frequency and Severity of Moral Distress in Nephrology Fellows: A National Survey

Session Information

Category: Educational Research

  • 800 Educational Research

Authors

  • Saeed, Fahad, University of Rochester Medical Center, Rochester, New York, United States
  • Duberstein, Paul, Rutgers School of Public Health, Piscataway, New Jersey, United States
  • Epstein, Ronald M., University of Rochester Medical Center, Rochester, New York, United States
  • Lang, Valerie J., University of Rochester Medical Center, Rochester, New York, United States
  • Liebman, Scott E., University of Rochester Medical Center, Rochester, New York, United States
Background

Moral distress is a negative affective response to a situation that conflicts with an individual’s values. Health care practitioners who care for chronically ill patients frequently experience moral distress. Little is known about the frequency and severity of moral distress in nephrology fellows.

Methods

We used the modified Moral Distress Scale-Revised to assess the frequency and severity of moral distress in nephrology fellows. Using a 5-point (0-4) scale, fellows rated both the frequency (never to very frequently) and severity (not at all disturbing to very disturbing) of scenarios commonly encountered in training. Responses of ≥ 3 were used to define “frequent” and “moderate-to-severe” moral distress. We identified scenarios most commonly associated with moderate-to-severe moral distress.
The survey was sent to 148 program directors with a request to forward to their fellows.

Results

The survey was forwarded by 64 fellowship directors to 386 fellows, 142 of whom (40%) responded. Their mean age was 33 ± 3.6 years; 43% were female; and 55% were international medical graduates. The most common scenarios causing moderate to severe moral distress include: Other providers giving overly optimistic descriptions of the benefits of acute (54% seeing frequently, 64% rating the distress as moderate to severe) or chronic dialysis (43%; 64%), initiating dialysis in patients when they deemed it futile (50%; 77%), continuing dialysis in a hopelessly ill patient (45%; 81%) and carrying a high patient census (43%, 75%). Approximately 27% considered quitting fellowship during training, including 9% at the time of survey completion.

Conclusion

Moral distress is frequently encountered by nephrology trainees and is often moderate to severe in intensity. To address this issue, organizational changes (e.g., reduced workload, ethics guidelines), curricular changes (emphasizing primary palliative care, communication, and ethical decision-making skills) as well as opportunities for reflection and self-care (e.g., Balint groups, Schwartz rounds) may be helpful.

Funding

  • NIDDK Support