Moral injury in neurointerventional practice: multinational survey

Area of Science:

• Neurointerventional Radiology
• Medical Ethics
• Occupational Psychology

Background:

• Neurointerventional practice involves high-stakes decisions and potential complications, leading to clinician distress.
• Traditional frameworks like burnout may not fully address ethical and identity-based distress in this field.
• Moral injury offers a relevant but unexplored lens for understanding neurointerventionalist distress.

Purpose of the Study:

• To explore the prevalence and impact of moral injury among neurointerventionalists.
• To identify organizational and systemic factors contributing to moral injury in this specialty.
• To assess the relationship between moral injury and professional disengagement.

Main Methods:

• Anonymous, multinational, cross-sectional survey of 212 neurointerventionalists and trainees.
• Assessment of ethically distressing situations, organizational culture, and institutional support.
• Exploratory analysis of associations between moral injury experiences and practice modification.

Main Results:

• 88% of respondents found moral injury highly relevant; 46% reported frequent emotional exhaustion.
• Common stressors included pressure to treat patients with low benefit and lack of support after complications (64%).
• 51% experienced negative professional impacts, 42% considered leaving neurointerventional practice, and 18% modified their duties.

Conclusions:

• Moral injury is prevalent in neurointerventional practice, significantly linked to organizational and systemic factors.
• It provides a framework for understanding workforce vulnerability and professional disengagement.
• Institution-level accountability, peer support, and cultural change are essential interventions.