120 Moral Distress Among Attending Neurosurgeons: A National Survey

Abstract

INTRODUCTION: “Moral distress” arises from the inability to carry out one's chosen decision or action because of constraints. Within medicine, moral distress may predispose to burnout and physician attrition and arises most dramatically from being forced to inflict aggressive, unwarranted, or non-beneficial treatment upon a patient. METHODS: An online survey evaluating moral distress and burnout among neurosurgical attendings was emailed to all members of the Congress of Neurological Surgeons in 2020; 269 neurosurgeons answered the survey. The moral distress survey consisted of 8 questions developed in-house and fitted to neurosurgical practice; burnout was gauged using Oldenburg Burnout Inventory (OLBI). Demographic characteristics were also collected. RESULTS: Nearly half (46.88%) of neurosurgeons experienced significant moral distress within the past year. The scenario encountered most frequently was caring for patients lacking clear treatment plans; the scenario eliciting the greatest intensity was providing aggressive treatment at the family’s insistence contrary to the surgeon’s judgment. Moral distress led 10.43% of neurosurgeons to leave a position. Neurosurgeons with burnout had higher moral distress scores. Our 8-question moral distress survey demonstrated excellent internal consistency (Cronbach alpha = 0.89). CONCLUSION: We developed an internally consistent and reliable 8-question survey assessing moral distress among neurosurgeons. Nearly half of neurosurgeons suffered moral distress within the past year, particularly from a lack of clarity around patient treatment goals and pressure to operate. Moral distress caused 10% of neurosurgeons to leave a position and was correlated with burnout risk.