523 - Moral Distress in Hospitalist Practice: A Tool to Assess Contributing Factors

Publication Number: 4511.523

Meera Singavi, Phoenix Children's Hospital, Phoenix, AZ, United States; Sandra Gage, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States

Background: Moral Distress (MD) constitutes a growing concern in healthcare and is known to be a significant cause for burnout, depression, and job dissatisfaction. Pediatric Hospitalists (PH) serve a unique role in healthcare systems, coordinating care between specialties, providing family-centered care for increasingly complex patients, and educating trainees. While studies have shown that common triggers for MD in providers vary, those cited include emotional exhaustion, depersonalization, and isolation. However, little is known about triggers of MD in PH.

Objective: To increase the understanding of triggers of MD among PH.

Design/Methods: This study was conducted at a large, free-standing quaternary children's hospital between 1/2024 and 12/2024. Study participation was voluntary and included all PH faculty and fellows. Demographic information collected included age by range. A survey was adapted from the Measure of Moral Distress (MMD) by author's permission (Epstein et. al. 2019). Our modified tool included 21 two-part Likert-scale items assessing (a) the frequency of exposure to moral distress triggers (0 = never, 4 = very frequently) and (b) the corresponding level of distress (0 = none, 4 = very distressing) and 1 multiple choice question about age. The surveys were distributed prior to 4 case discussions identified as possible causes of MD. Composite scores of MD triggers were generated by multiplying frequency of each trigger by its distress rating and then calculating the mean. Highest triggers of MD were grouped according to topic themes. Total impact of MD per participant was calculated by adding their trigger composite scores. Total scores were compared by age range.

Results: Of 70 eligible hospitalists, 10-20 participated in each session, with 42 surveys completed (age breakdown: Table 1). Triggers of MD were ranked by mean composite scores (Table 2). Distinct themes of most common triggers emerged including challenging interactions with patients' families, breakdowns in team communication, and the strain of high clinical volume. When comparing scores of MD by age, there was a notable difference between the lower and higher age groups (Table 1).

Conclusion(s): Specific themes of MD triggers in PH were identified by using the modified MMD. These themes, unique to PH, focused on challenging family interactions, barriers to communication, and high volume. Notably, younger PH appeared to experience greater MD in our population. This information will inform future education in our division, focusing on younger providers. This tool may prove beneficial to other hospitalist groups to assess MD triggers.

Table 1
Age group and mean composite score for Likert scale questions on pre-session MMD (modified)

Table 2
Mean composite score for Likert scale questions on pre-session MMD (modified)