Addressing clinician moral distress: Implications from a mixed methods evaluation during Covid-19

Area of Science:

• Healthcare ethics
• Clinical psychology
• Public health

Background:

• Clinician moral distress is a recognized issue, particularly concerning end-of-life decisions.
• The COVID-19 pandemic exacerbated moral distress due to high mortality and complex decision-making.
• Understanding moral distress within the Veterans Health Administration (VA) is crucial for clinician and patient well-being.

Purpose of the Study:

• To examine the prevalence of clinician moral distress among VA clinicians during the COVID-19 pandemic.
• To identify demographic and professional factors associated with moral distress.
• To explore circumstances contributing to moral distress.

Main Methods:

• A convergent mixed methods study using an online survey of VA clinicians at 20 VA Medical Centers.
• Quantitative data collected on demographics, clinical practice, and moral distress intensity during peak COVID-19.
• Qualitative data gathered through an open-ended item on contributing circumstances, analyzed thematically.

Main Results:

• 81% of 323 respondents reported moral distress during peak COVID-19.
• Female gender was associated with increased odds of moral distress.
• Geriatrics/palliative care and internal/family/primary care were associated with reduced moral distress.
• Key contributors included patient visitation restrictions, clinical uncertainty, resource shortages, and personal risk.

Conclusions:

• Clinician moral distress was highly prevalent during the early COVID-19 pandemic.
• Moral distress stemmed from individual, system, and situational factors.
• Identified contributors offer targets for interventions to mitigate moral distress in future crises and routine care.