Katherine Guttmann1, John Flibotte2, Holli Seitz3, Matthew Huber2, Sara B DeMauro2. 1. Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Dr. Guttmann is now affiliated with the Division of Newborn Medicine, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: katherine.guttmann@mssm.edu. 2. Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. 3. Department of Communication, Mississippi State University, Mississippi State, MS, USA.
Abstract
CONTEXT: The relationship between quality of Goals of Care (GOC) conversations and moral distress among NICU providers is not known. OBJECTIVES: We sought: 1) to explore levels of moral distress in providers, 2) to evaluate how staff moral distress changes in relation to GOC discussions and 3) to identify elements of GOC discussions associated with change in moral distress. We hypothesized that staff moral distress would change after GOC discussions and that that change would vary with presence of key discussion elements. METHODS: Prospective cohort study in a level IV NICU in an urban teaching hospital. We administered validated instruments at baseline and following GOC discussions including the Moral Distress Thermometer (MDT) and Williams Instrument (a measure of end-of-life care) to physicians, nurses, and social workers. RESULTS: We collected data on 79 GOC conversations over a one-year period from 2018-2019. Most providers experienced an increase in moral distress following a GOC discussion. Providers experienced an average increase in moral distress, as measured by the MDT, of 0.84 (+/-3.15) (p=.002). Physicians experienced an average change in moral distress of 1.1 (+/-3.52) (p= 0.01) while nurses experienced an average change of .55 (+/-2.66) (p= 0.07). Several elements of discussions were associated with the degree of increase in moral distress after the conversation. CONCLUSION: Change in moral distress among providers may be a useful metric of quality of GOC discussions. There are identifiable elements of GOC conversations that are associated with high quality discussions. These elements warrant further study.
CONTEXT: The relationship between quality of Goals of Care (GOC) conversations and moral distress among NICU providers is not known. OBJECTIVES: We sought: 1) to explore levels of moral distress in providers, 2) to evaluate how staff moral distress changes in relation to GOC discussions and 3) to identify elements of GOC discussions associated with change in moral distress. We hypothesized that staff moral distress would change after GOC discussions and that that change would vary with presence of key discussion elements. METHODS: Prospective cohort study in a level IV NICU in an urban teaching hospital. We administered validated instruments at baseline and following GOC discussions including the Moral Distress Thermometer (MDT) and Williams Instrument (a measure of end-of-life care) to physicians, nurses, and social workers. RESULTS: We collected data on 79 GOC conversations over a one-year period from 2018-2019. Most providers experienced an increase in moral distress following a GOC discussion. Providers experienced an average increase in moral distress, as measured by the MDT, of 0.84 (+/-3.15) (p=.002). Physicians experienced an average change in moral distress of 1.1 (+/-3.52) (p= 0.01) while nurses experienced an average change of .55 (+/-2.66) (p= 0.07). Several elements of discussions were associated with the degree of increase in moral distress after the conversation. CONCLUSION: Change in moral distress among providers may be a useful metric of quality of GOC discussions. There are identifiable elements of GOC conversations that are associated with high quality discussions. These elements warrant further study.
Authors: Sara Carletto; Maria Chiara Ariotti; Giulia Garelli; Ludovica Di Noto; Paola Berchialla; Francesca Malandrone; Roberta Guardione; Floriana Boarino; Maria Francesca Campagnoli; Patrizia Savant Levet; Enrico Bertino; Luca Ostacoli; Alessandra Coscia Journal: Int J Environ Res Public Health Date: 2022-07-12 Impact factor: 4.614