Moral distress in Pediatric otolaryngology: A survey of ASPO members

1. Determine the prevalence of moral distress for pediatric otolaryngologists in North America. 2. Evaluate the impact of demographic variables on moral distress levels.

Moral distress is defined as "when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action". The Moral Distress Survey-Revised (MDS-R) is a 21-question survey measuring moral distress in pediatric patients. A modified MDS-R (validated with pilot data in pediatric otolaryngology) was anonymously distributed to American Society of Pediatric Otolaryngology (ASPO) members. Descriptive statistics, bivariate and multivariate analysis were performed.

Response rate was 86/656 (13 %). Mean modified MDS-R score was 49 (range 3-128), which is lower than that found in the literature for pediatric surgeons (mean 72), pediatric intensivists (means 57-86), and similar to pediatric oncologists (reported means 42-52). Female respondents had higher MDS-R scores than males (60 vs. 50). Providers in practice <20 years had higher moral distress scores than those practicing >20 years (54 vs. 43). Factors leading to higher degrees of distress involved communication breakdowns/lack of provider continuity and seeing other providers provide false hope to patients.

Pediatric Otolaryngologists have low degrees of moral distress compared to other pediatric subspecialists. Those with fewer years of experience have higher levels of moral distress. Further research is necessary to determine the impact of moral distress on the wellness of pediatric otolaryngologists.