Physician Moral Distress and End-of-Life Physician-Parent Communication and Care

Abstract

Objective: By exploring perspectives of pediatric specialists on end-of-life (EOL) communication and care through narrative interviews, we aim to examine the extent to which interactions about death lead to feelings of moral distress. Methods: 17 pediatric emergency medicine and pediatric critical care physicians practicing in a 380-bed academic children’s medical center in the southeast went through 2 rounds of narrative interviews. The overarching interview question in Phase I was: “How has your background influenced the way you communicate with and care for dying children and their families?” The data generated from the interviews in Phase I led to additional questions and topics for exploration in Phase II. Grounded theory informed the design of this study and analysis of the data. Results: Although most participants felt that EOL decisions were the families’ jurisdiction, the physicians described experiencing moral distress in some cases, especially when they felt they were forced to put the parents’ prerogatives over the child-patients’ best interests. Moral distress ensued from observing other physicians withdrawing life-sustaining care too soon, from parents prolonging care contrary to what these physicians thought were the child best interests, and issues surrounding resuscitation and organ donation. Conclusion: Research indicates that physician burnout is more prevalent among those physicians in palliative care who feel inadequately trained in communication skills. In addition to promoting better patient care, more education and training in communication and EOL issues may prevent physician moral distress which can decrease physician burnout and ensure more efficacious humane patient care.