Table 2.
Nephrology fellows’ ratings of the frequency and degree of moral distress caused by each situation presented in the adapted Moral Distress Scales-Revised (n = 121)
| Frequency of situation*, n (%) | Severity of moral distress*, n (%) | |||||
|---|---|---|---|---|---|---|
| never (0) | rarely to sometimes (1–2) | often to frequently (3–4) | none (0) | mild to low moderate (1–2) | moderate to severe (3–4) | |
| (1) Dialysis decision-making | ||||||
| (a) Witness other health care providers provide overly optimistic information regarding the benefits of acute dialysis in critically ill patients | 9 (7.6) | 45 (38.1) | 64 (54.2) | 2 (1.7) | 39 (33.9) | 74 (64.3) |
| (b) Witness other health care providers provide overly optimistic information regarding the benefits of chronic dialysis | 13 (11.0) | 54 (45.8) | 51 (43.2) | 1 (0.8) | 40 (35.1) | 73 (64.0) |
| (c) Dialyze patients in a situation in which they or their family members have not been given adequate information to ensure an informed consent | 35 (30.4) | 64 (55.7) | 16 (13.9) | 1 (0.9) | 30 (26.3) | 83 (72.8) |
| (2) Futility of dialysis | ||||||
| (a) Initiate renal replacement therapy when you think it is futile | 10 (8.6) | 48 (41.0) | 59 (50.4) | 3 (2.6) | 24 (20.9) | 88 (76.5) |
| (b) Follow family’s wishes to continue dialysis even though you believe it is not in the best interest of a patient who does not have the capacity to make his/her own decision | 4 (3.5) | 50 (43.1) | 62 (53.4) | 0 (0.00) | 27 (23.7) | 87 (76.3) |
| (c) Continue to provide renal replacement therapy for a hopelessly ill patient when no one will make a decision to withdraw support | 12 (10.3) | 52 (44.8) | 52 (44.8) | 0 (0) | 22 (19.3) | 92 (80.7) |
| (d) Withhold dialysis per family request in a patient unable to make his/her own choices when you feel providing dialysis is appropriate | 67 (57.8) | 39 (33.6) | 10 (8.6) | 4 (3.6) | 30 (26.8) | 78 (69.6) |
| (3) Institutional or fellowship programs’ culture | ||||||
| (a) Feel pressure to see and write a note on a patient when you feel that your input will not change management | 12 (10.3) | 47 (40.5) | 57 (49.1) | 11 (9.6) | 54 (47) | 50 (43.5) |
| (b) Have too high a patient census such that you are unable to provide quality care | 11 (9.4) | 56 (47.9) | 50 (42.7) | 2 (1.74) | 27 (23.5) | 86 (75) |
| (c) Do procedures with inadequate supervision | 91 (78.5) | 18 (15.5) | 7 (6.0) | 13 (11.4) | 18 (15.8) | 83 (72.8) |
| (4) Interdisciplinary communication | ||||||
| (a) Follow the primary physician’s request not to discuss the patient’s prognosis with the patient or family | 63 (54.3) | 43 (37.1) | 10 (8.6) | 3 (2.6) | 34 (29.8) | 77 (67.6) |
| (b) Witness diminished quality of care due to poor team communication | 12 (10.3) | 77 (62.4) | 32 (27.4) | 0 (0.00) | 32 (28.1) | 82 (71.9) |
| (c) Feel pressure to withhold your opinion when you disagree with the primary medical team’s plan of care | 25 (21.4) | 61 (57.3) | 25 (21.4) | 1 (0.8) | 40 (34.8) | 74 (64.4) |
| (5) Power dynamics | ||||||
| (a) Provide recommendations for patient care that you do not agree with based on your attending physician’s opinion | 24 (20.5) | 77 (65.8) | 16 (13.6) | 4 (3.5) | 47 (41.2) | 63 (55.3) |
| (b) Take no action when a physician or nurse colleague has made a medical error and does not report it | 75 (65.8) | 31 (27.2) | 8 (7.0) | 3 (2.7) | 28 (25.1) | 82 (72.6) |
| (c) Take no action about an observed ethical issue because the involved staff member or someone in a position of authority requests that you do nothing | 82 (71.3) | 28 (24.3) | 5 (4.3) | 1 (0.89) | 13 (11.6) | 98 (87.5) |
*
The number of responses for each item is <142 as some respondents did not answer all the questions. Moreover, some participants responded to the frequency item but did not respond to the severity item.