Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study.
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Authors
Dzeng, Elizabeth
Colaianni, Alessandra
Levine, David
Smith, Thomas J
Publication Date
2016-01Journal Title
J Gen Intern Med
ISSN
0884-8734
Publisher
Springer Science and Business Media LLC
Volume
31
Pages
93-99
Language
English
Type
Article
Metadata
Show full item recordCitation
Dzeng, E., Colaianni, A., Roland, M., Levine, D., Kelly, M., Barclay, S., & Smith, T. J. (2016). Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study.. J Gen Intern Med, 31 93-99. https://doi.org/10.1007/s11606-015-3505-1
Abstract
BACKGROUND: Ethical challenges are common in end of life care; the uncertainty of prognosis and the ethically permissible boundaries of treatment create confusion and conflict about the balance between benefits and burdens experienced by patients. OBJECTIVE: We asked physician trainees in internal medicine how they reacted and responded to ethical challenges arising in the context of perceived futile treatments at the end of life and how these challenges contribute to moral distress. DESIGN: Semi-structured in-depth qualitative interviews. PARTICIPANTS: Twenty-two internal medicine residents and fellows across three American academic medical centers. APPROACH: This study uses systematic qualitative methods of data gathering, analysis and interpretation. KEY RESULTS: Physician trainees experienced significant moral distress when they felt obligated to provide treatments at or near the end of life that they believed to be futile. Some trainees developed detached and dehumanizing attitudes towards patients as a coping mechanism, which may contribute to a loss of empathy. Successful coping strategies included formal and informal conversations with colleagues and superiors about the emotional and ethical challenges of providing care at the end of life. CONCLUSIONS: Moral distress amongst physician trainees may occur when they feel obligated to provide treatments at the end of life that they believe to be futile or harmful.
Sponsorship
This study was funded by the Health Resources and Service Administration T32 HP10025-20 Training Grant, the Gates Cambridge Scholarship, Society of General Internal Medicine Founders Grant, and the Ho-Chiang Palliative Care Research Fellowship at the Johns Hopkins School of Medicine.
Identifiers
External DOI: https://doi.org/10.1007/s11606-015-3505-1
This record's URL: https://www.repository.cam.ac.uk/handle/1810/250447
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