Prevalence and Risk Factors of Moral Distress Among Surgeons Specialized in Oncology Care

Moral distress, the negative emotions associated with the inability to do the right thing due to imposed constraints, is prevalent among health care workers but underexplored among surgeons.

This was a cross-sectional study in October 2024 using the Measure of Moral Distress for Healthcare Professionals (MMD-HP) survey distributed to the Division of Surgery at a comprehensive cancer center. Descriptive statistics as well as Mann-Whitney U, Kruskal-Wallis, and Fisher's exact tests were used to compare group differences.

The overall response rate was 19.3 % (45/233). Among the respondents, 48.9 % were female (n = 22), 24.4 % were racial and ethnic minorities % (n = 11), and 28.9 % were trainees (n = 13). The top surgical specialties included surgical oncology (n = 22, 48.9 %), breast surgical oncology (n = 7, 15.6 %), and gynecologic oncology (n = 8, 17.8 %). Of the respondents, 28.9 % (n = 13) practiced in an acute/intensive care setting, and 26.7 % (n = 12) received previous palliative care training. All the respondents reported moral distress (median, MMD-HP score, 61; interquartile range [IQR], 33-86). Because of moral distress, 24 % (n = 11) considered leaving or had left a clinical position, and 8.9 % (4) considered leaving their current position. Those who intended to leave had significantly higher scores than those who did not (p < 0.05). The MMD-HP scores did not differ significantly by demographics, trainee versus faculty role, surgical subspecialty, or palliative care experience. The top sources of moral distress centered around patient- and team-level interactions.

In this cohort of surgeons specialized in oncology care, moral distress was highly prevalent and driven by patient-, team-, and system-level factors. These findings may help inform the development of interventions aimed at mitigating moral distress for current and future generations of surgeons.