Clinicians’ perceptions about institutional factors in moral distress related to potentially nonbeneficial treatments

Clinicians’ perceptions about institutional factors in moral distress related to potentially nonbeneficial treatments
JAMA Network Open; by Teva D. Brender, Julia K. Axelrod, Sofia Weiss Goitiandia, Jason N. Batten, Elizabeth W. Dzeng; 6/25
In this qualitative study, we described institutional factors that may exacerbate, prevent, or mitigate the influence of societal factors contributing to moral distress related to potentially nonbeneficial LST [life-sustaining treatments]. Health systems should consider how health care consumerism influences patients’, families’, and clinicians’ expectations regarding potentially nonbeneficial LST, particularly at hospitals with advanced technological interventions (eg, organ transplantation, extracorporeal membrane oxygenation, salvage chemotherapies). Future studies should explore the societal and institutional factors contributing to moral distress for clinicians at lower-resourced hospitals, such as inaccessible advanced treatments and barriers to transferring patients for higher levels of care. While some institutions lacked sufficient structures to support clinicians’ efforts to de-escalate potentially nonbeneficial treatments, policies empowering clinicians across the medical hierarchy, as well as conflict resolution and emotional support resources (eg, palliative care) might prevent or mitigate moral distress.