Understanding Experiences of Moral Distress in End-of-Life Care Among US and UK Physician Trainees: a Comparative Qualitative Study.
Understanding Experiences of Moral Distress in End-of-Life Care Among US and UK Physician Trainees: a Comparative Qualitative Study.
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DOI：
10.1007/s11606-020-06314-y
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发表时间：
2021-07
影响因子：
5.7
通讯作者：
Dzeng E
中科院分区：
文献类型：
--
作者：
Rosenwohl-Mack S;Dohan D;Matthews T;Batten JN;Dzeng E
道德困扰是指临床医生由于外部约束而不能按照其道德信念行事的状态。实习医生在严格的等级制度下工作，缺乏临床经验，特别容易受到道德困扰。我们通过比较两个不同国家文化和医疗保健系统的经验，研究了实习医生在临终关怀中的道德困扰的动态。我们调查了在美国和英国的文化因素，可能会产生道德困扰在各自的医疗系统，以及这些因素如何塑造医生实习生的道德困扰的经验。关于临终关怀和道德困扰的经验的半结构化深入定性访谈。美国有16名内科住院医师，英国有14名初级医生。本研究采用主题分析法对研究进行分析。美国和英国受训人员的道德困扰的一些驱动因素是相似的，包括提供潜在的不适当的治疗，定义不明确的护理轨迹，以及多个团队的参与，创造不同的护理期望。对于英国学员，医疗团队的等级制度是常见的，而对于美国学员，来自家庭的压力，缺乏阻止不适当治疗的指导方针，以及对身体伤害患者的困扰经常被引用。美国学员描述了患者自主权和对诉讼的恐惧如何导致道德困扰，而英国学员则描述了围绕资源分配的社会期望如何减轻道德困扰。这项研究强调了美国和英国医生学员之间不同的道德困扰经历如何受到各自国家医疗文化的影响。这项研究说明了如何道德困扰的经验反映了更广泛的文化中，它发生，并建议如何受训者可能特别容易受到it.Clinicians和医疗保健领导人在这两个国家可以互相学习有关政策和做法，可能会减少道德困扰受训者的经验。
Moral distress is a state in which a clinician cannot act in accordance with their ethical beliefs because of external constraints. Physician trainees, who work within rigid hierarchies and who lack clinical experience, are particularly vulnerable to moral distress. We examined the dynamics of physician trainee moral distress in end-of-life care by comparing experiences in two different national cultures and healthcare systems. We investigated cultural factors in the US and the UK that may produce moral distress within their respective healthcare systems, as well as how these factors shape experiences of moral distress among physician trainees. Semi-structured in-depth qualitative interviews about experiences of end-of-life care and moral distress. Sixteen internal medicine residents in the US and fourteen junior doctors in the UK. The work was analyzed using thematic analysis. Some drivers of moral distress were similar among US and UK trainees, including delivery of potentially inappropriate treatments, a poorly defined care trajectory, and involvement of multiple teams creating different care expectations. For UK trainees, healthcare team hierarchy was common, whereas for US trainees, pressure from families, a lack of guidelines for withholding inappropriate treatments, and distress around physically harming patients were frequently cited. US trainees described how patient autonomy and a fear of lawsuits contributed to moral distress, whereas UK trainees described how societal expectations around resource allocation mitigated it. This research highlights how the differing experiences of moral distress among US and UK physician trainees are influenced by their countries’ healthcare cultures. This research illustrates how experiences of moral distress reflect the broader culture in which it occurs and suggests how trainees may be particularly vulnerable to it. Clinicians and healthcare leaders in both countries can learn from each other about policies and practices that might decrease the moral distress trainees experience.
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影响因子：
5.1
作者：
Hooper, Patricia;Kocman, David;Tarrant, Carolyn
通讯作者：
Tarrant, Carolyn
影响因子：
2.8
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影响因子：
4.4
作者：
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通讯作者：
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影响因子：
2.6
作者：
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通讯作者：
Hillman, K.
影响因子：
1.7
作者：
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通讯作者：
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