期刊
JOURNAL OF GENERAL INTERNAL MEDICINE
卷 35, 期 5, 页码 1405-1412出版社
SPRINGER
DOI: 10.1007/s11606-020-05652-1
关键词
physician moral distress; surrogate decision-making; geriatric patients
资金
- Research in Palliative and End-of Life Communication and Training (RESPECT) Signature Center, Indiana University-Purdue University Indianapolis
- Greenwall Foundation
- National Institute on Aging [R01 AG044408, K24AG053794]
Background When working with surrogate decision-makers, physicians often encounter ethical challenges that may cause moral distress which can have negative consequences for physicians. Objective To determine frequency of and factors associated with physicians' moral distress caring for patients requiring a surrogate. Design Prospective survey. Participants Physicians (n = 154) caring for patients aged 65 years and older and their surrogate decision-makers (n = 362 patient/surrogate dyads). Patients were admitted to medicine or medical intensive care services, lacked decisional capacity and had an identified surrogate. Main Measures Moral distress thermometer. Key Results Physicians experienced moral distress in the care of 152 of 362 patients (42.0%). In analyses adjusted for physician, patient, and surrogate characteristics, physician/surrogate discordance in preferences for the plan of care was not significantly associated with moral distress. Physicians were more likely to experience moral distress when caring for older patients (1.06, 1.02-1.10), and facing a decision about life-sustaining treatment (3.58, 1.54-8.32). Physicians were less likely to experience moral distress when caring for patients residing in a nursing home (0.40, 0.23-0.69), patients who previously discussed care preferences (0.56, 0.35-0.90), and higher surrogate ratings of emotional support from clinicians (0.94, 0.89-0.99). Physicians' internal discordance when they prefer a more comfort-focused plan than the patient is receiving was associated with significantly higher moral distress (2.22, 1.33-3.70) after adjusting for patient, surrogate, and physician characteristics. Conclusions Physician moral distress occurs more frequently when the physician is male, the patient is older or requires decisions about life-sustaining treatments. These findings may help target interventions to support physicians. Prior discussions about patient wishes is associated with lower distress and may be a target for patient-centered interventions.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据