Moral distress is ‘pervasive’ in radiology, with 4 primary causes
Moral distress is “pervasive” in radiology with four primary causes, according to new research published Monday.
This phenomenon has emerged as a key contributor to burnout in medicine, rising up the list of recognized factors, experts write in JACR. Moral distress describes when radiologists are unable to provide proper care to patients because of perceived constraints.
Priya Dave, MD, and co-authors analyzed how moral distress manifests across differing organizations, surveying 126 individuals at five academic institutions in five states. A “strong” association between high distress levels and one’s intent to leave a job “highlights its impact on workforce retention,” the authors contend.
“Causes of moral distress need to be accurately identified such that initiatives to prevent them can be successful,” Dave et al. wrote April 7. “This study aimed to investigate whether the most common causes of moral distress vary across different academic radiology departments.”
Researchers conducted the survey using the Moral Distress Scale-Revised for Health Care Professionals to gauge burnout severity among rads. They sent the survey to members of the Radiological Society of North America (RSNA) quality committee to be distributed to their departments. Moral distress levels appeared higher among radiologists working more than 60 hours per week, the authors noted.
Across all five institutions, four main sources of moral distress bubbled to the surface. They included pressure to perform an unsafe number of studies (cited by 85% of respondents), high workloads impeding resident teaching (81%), lack of administrative support for patient care issues (81%), and pressure to conduct unnecessary imaging (88%). Higher moral distress correlated “significantly” with turnover intentions or past job changes, the survey found. The average percentage of radiologists who had left a job or intended to was 44% with a range of 26% to 84%.
The authors underlined leadership’s crucial role in mitigating moral distress. A survey at lead author Dave’s institution, the Mayo Clinic, found that management styles which correlated with wellness sought to “inform, engage, inspire, develop and recognize.” Follow-up analyses unearthed the importance of three main principles—“care about people always,” “cultivate individual and team relationships,” and “inspire change.”
“Particular emphasis has to be placed on leadership listening to problems experienced at the frontlines and actually addressing them,” the authors advised. “Such leadership styles foster a greater sense of clinician autonomy and control, and as such are positively associated with wellness,” they added later. “These leadership behaviors are particularly embodied in servant leadership which has been proven successful in addressing burnout.”
Leadership education on moral distress is one possible remedy, along with ethics training in radiology, previous studies have deduced. Open-ended responses to this latest JACR survey revealed other possible remedies. These include improved staffing and resources, reasonable workload expectations, improved workflow and efficiencies, fair compensation and benefits, fostering collegiality and community, transparent and supportive leadership, and raising awareness about moral distress.
“Future research could show the success of these countermeasures,” the authors added.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.