Dodek Peter M, Cheung Elaine O, Burns Karen E A, Martin Claudio M, Archambault Patrick M, Lauzier Francois, Sarti Aimee J, Mehta Sangeeta, Fox-Robichaud Alison E, Seely Andrew J E, Parshuram Christopher, Garros Daniel, Withington Davinia E, Cook Deborah J, Piquette Dominique, Carnevale Franco A, Boyd J Gordon, Downar James, Kutsogiannis D James, Chassé Michael, Fontela Patricia, Fowler Robert A, Bagshaw Sean, Dhanani Sonny, Murthy Srinivas, Gehrke Paige, Fujii Tomoko
Center for Health Evaluation and Outcome Sciences.
Division of Critical Care Medicine, and.
Ann Am Thorac Soc. 2021 Aug;18(8):1343-1351. doi: 10.1513/AnnalsATS.202009-1118OC.
Understanding the magnitude of moral distress and its associations may point to solutions. To understand the magnitude of moral distress and other measures of wellness in Canadian critical care physicians, to determine any associations among these measures, and to identify potentially modifiable factors. This was an online survey of Canadian critical care physicians whose e-mail addresses were registered with either the Canadian Critical Care Society or the Canadian Critical Care Trials Group. We used validated measures of moral distress, burnout, compassion fatigue, compassion satisfaction, and resilience. We also measured selected individual, practice, and workload characteristics. Of the 499 physicians surveyed, 239 (48%) responded and there were 225 usable surveys. Respondents reported moderate scores of moral distress (107 ± 59; mean ± standard deviation, maximum 432), one-third of respondents had considered leaving or had previously left a position because of moral distress, about one-third met criteria for burnout syndrome, and a similar proportion reported medium-high scores of compassion fatigue. In contrast, about one-half of respondents reported a high score of compassion satisfaction, and overall, respondents reported a moderate score of resilience. Each of the "negative" wellness measures (moral distress, burnout, and compassion fatigue) were associated directly with each of the other "negative" wellness measures, and inversely with each of the "positive" wellness measures (compassion satisfaction and resilience), but moral distress was not associated with resilience. Moral distress was lower in respondents who were married or partnered compared with those who were not, and the prevalence of burnout was lower in respondents who had been in practice for longer. There were no differences in any of the wellness measures between adult and pediatric critical care physicians. Canadian critical care physicians report moderate scores of moral distress, burnout, and compassionate fatigue, and moderate-high scores of compassion satisfaction and resilience. We found no modifiable factors associated with any wellness measures. Further quantitative and qualitative studies are needed to identify interventions to reduce moral distress, burnout, and compassion fatigue.
了解道德困扰的程度及其关联因素可能会指向解决方案。旨在了解加拿大重症监护医师的道德困扰程度及其他健康指标，确定这些指标之间的任何关联，并识别潜在的可改变因素。这是一项针对加拿大重症监护医师的在线调查，其电子邮件地址已在加拿大重症监护协会或加拿大重症监护试验组注册。我们使用了经过验证的道德困扰、职业倦怠、同情疲劳、同情满足感和心理韧性的测量方法。我们还测量了选定的个人、实践和工作量特征。在接受调查的499名医生中，239名（48%）做出了回应，得到了225份可用的调查问卷。受访者报告的道德困扰得分中等（107±59；平均值±标准差，最高432），三分之一的受访者曾因道德困扰考虑过离职或此前已离职，约三分之一的受访者符合职业倦怠综合征的标准，类似比例的受访者报告同情疲劳得分中高。相比之下，约一半的受访者报告同情满足感得分较高，总体而言，受访者报告心理韧性得分中等。每一项“负面”健康指标（道德困扰、职业倦怠和同情疲劳）都与其他“负面”健康指标直接相关，与“正面”健康指标（同情满足感和心理韧性）呈负相关，但道德困扰与心理韧性无关。已婚或有伴侣的受访者的道德困扰低于未婚者，从业时间较长的受访者职业倦怠的患病率较低。成人和儿科重症监护医师在任何健康指标上均无差异。加拿大重症监护医师报告的道德困扰、职业倦怠和同情疲劳得分中等，同情满足感和心理韧性得分中高。我们未发现与任何健康指标相关的可改变因素。需要进一步开展定量和定性研究，以确定减少道德困扰、职业倦怠和同情疲劳的干预措施。
