Genetic counselors providing care to inpatients experience moral distress

Moral distress is defined as a negative emotional response that occurs when healthcare professionals cannot carry out what they believe are ethically appropriate actions because of constraints or barriers. The prevalence of moral distress is high among inpatient healthcare providers and has been previously studied in genetic counselors (GCs). It has never been studied, however, among GCs with inpatient roles. This mixed methods study comprised a survey to assess moral distress using the previously validated Measure of Moral Distress-Healthcare Professionals (MMD-HP), followed by semi-structured interviews to further explore the prevalence and experience of moral distress and coping mechanisms to heal from moral distress. Twenty-five GCs who provided inpatient care completed the survey, 10 completed interviews. The survey identified that most (60%; n = 15) GCs in this study were new to the inpatient role, with less than 3 years of experience. The most prevalent sources of moral distress on the MMD-HP included watching patient care suffer because of poor provider continuity and feeling pressured to order or carry out orders for unnecessary/inappropriate tests. Themes from the interviews included: witnessing poor and inconsistent care, lack of time to provide care, pressure to obtain consent, support is needed to manage moral distress, and years of experience in the inpatient role alters the experience of moral distress. Talking with colleagues was the most common mechanism for healing from moral distress. Solutions to reducing moral distress included more administrative support, development of guidelines to promote consistent care, and provider education on the inpatient GC role and appropriate consent. Raising awareness of sources of moral distress among inpatient GCs is vital as the field of inpatient genetic counseling expands, as anticipatory guidance may be able to be provided to new inpatient GCs. Reducing moral distress among inpatient GCs is vital to retaining GCs in these roles.