Systematic scoping review on moral distress among physicians
Chrystie Wan Ning Quek1,2, Ryan Rui Song Ong1,2, Ruth Si Man Wong1,2
1Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
BMJ Open
|January 23, 2023
Summary
Moral distress (MD) in physicians involves conflicts between personal values and actions, influenced by various factors. Understanding these conflicts offers a personalized approach to managing MD and preventing burnout.
Area of Science:
- Medical Ethics
- Physician Well-being
- Psychological Distress
Background:
- Physician moral distress (MD) concepts have evolved beyond simple psychological distress.
- MD arises from constraints preventing physicians from acting on their ethical knowledge.
- Numerous personal, professional, legal, ethical, and moral issues contribute to MD.
Purpose of the Study:
- To review and map current understandings of moral distress among physicians.
- To provide a comprehensive overview of the evolving concept of MD in medical practice.
Main Methods:
- A systematic evidence-based scoping review of multiple databases (PubMed, Embase, PsycINFO, Web of Science, SCOPUS, ERIC, Google Scholar).
- Concurrent and independent thematic and direct content analysis of included articles.
- Jigsaw perspective used to combine themes and categories into discussion domains.
Main Results:
- 128 articles were included from over 30,000 abstracts.
- Five key domains were identified: current concepts, risk factors, impact, tools, and interventions.
- MD involves conflicts within physicians' personal beliefs and values due to multifaceted factors.
Conclusions:
- Moral distress stems from conflicts in personal beliefs influenced by diverse factors, impacting physician identity.
- The ring theory of personhood helps understand how experiences create dissonance and resonance.
- A new, broader concept of MD and personalized assessment/treatment approaches are proposed to support physicians and prevent burnout.
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