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Moral distress among physicians caring for older adults a persistent strain of burnout

Moral distress has been correlated with traumatic stress, burnout, depression and even intent to leave a position or profession.

Jeff Lagasse, Associate Editor

Time and again the data has shown that physicians are increasingly feeling the effects of burnout, and this is affecting everything from their job satisfaction to the quality of care patients receive. But there's a particular strain of burnout that's prevalent among those who care for older adults: moral distress.

In a new study, researchers from Regenstrief Institute, Indiana University School of Medicine and Indiana University Health provide insight into physician moral distress, a condition correlated with burnout and depression, reporting that about four of 10 doctors caring for older adult patients who require a surrogate decision-maker experienced moral distress.

Moral distress is an emotional experience in which an individual feels constrained from acting on deeply held beliefs, resulting in the sense of compromising one's professional integrity. Moral distress has been correlated with traumatic stress, burnout, depression and even intent to leave a position or profession.

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When hospitalized older adults have impaired cognition, family members or other surrogates communicate with clinicians to provide information about the patient and to make medical decisions for them. When working with these surrogate decision makers, physicians often encounter ethical challenges -- such as whether to continue life support or not -- that may cause them to experience moral distress with its potential negative consequences.


Physician moral distress occurred more frequently when the physician was male; the physician was an intern or other junior level doctor; the patient was older; or decisions were required about life-sustaining treatments.

The authors found that physicians were less likely to experience moral distress when caring for patients residing in a nursing home; the physician or family members had discussed care preferences with the patient before that individual became unable to make his or her own decisions; the surrogate decision maker felt emotionally supported by the physician and other clinicians; and whether or not the physician and surrogate decision maker agreed on the course of treatment.

What that all boils down to is that communication is key when it comes to ameliorating moral distress among medical professionals. Since this distress was diminished when the surrogate decision maker felt supported, efforts to address moral distress should focus on surrogates as well as the physicians themselves, the authors wrote.

A total of 362 surrogate decision makers of older adult patients who lacked decisional capacity and 152 physicians carrying for these patients were surveyed for the study. The researchers found that a significant cause of physician moral distress was related to the feeling that the care plan included more life-sustaining treatment for the patient than the physician believed was appropriate.


The issue of burnout and depression continues to have a significant impact on physicians' personal and professional lives, and Generation X physicians are more likely to experience it than their older and younger colleagues, found a January Medscape report.

When viewed by generation, 48% of all Gen X physicians reported burnout, as compared with 38% of millennials and 39% of baby boomer physicians. Female physicians overall are 25% more likely to report burnout (48%, vs. 37% of men), and one in five Gen X women report depression.

The Medscape report echoes findings from the National Academy of Medicine, which found in October that clinician burnout is affecting between one-third and one-half of all of U.S. nurses and physicians, and 45 to 60% of medical students and residents.

It found a direct connection between clinician burnout and quality and safety in healthcare. Clinician burnout isn't a new problem, but it appears to be getting worse due to factors that are inherent in today's healthcare system.

Twitter: @JELagasse

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