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. 2022 Sep 2;12(9):e064029.
doi: 10.1136/bmjopen-2022-064029.

Systematic scoping review on moral distress among physicians

Chrystie Wan Ning Quek  1   2 , Ryan Rui Song Ong  1   2 , Ruth Si Man Wong  1   2 , Sarah Wye Kit Chan  1   2 , Amanda Kay-Lyn Chok  1   2 , Grace Shen Shen  1   2 , Andrea York Tiang Teo  1   2 , Aiswarya Panda  1   2 , Neha Burla  1   2 , Yu An Wong  1   2 , Ryan Choon Hoe Chee  1   2 , Caitlin Yuen Ling Loh  1   2 , Kun Woo Lee  1   2 , Gabrielle Hui Ning Tan  1   2 , Ryan Emmanuel Jian Leong  1   2 , Natalie Song Yi Koh  1   2 , Yun Ting Ong  1   2 , Annelissa Mien Chew Chin  3 , Min Chiam  4 , Crystal Lim  5 , Xuelian Jamie Zhou  2   6 , Simon Yew Kuang Ong  4   6 , Eng Koon Ong  2   6 , Lalit Kumar Radha Krishna  7   2   4   6   8   9   10
Affiliations

Systematic scoping review on moral distress among physicians

Chrystie Wan Ning Quek et al. BMJ Open. .

Abstract

Background: Concepts of moral distress (MD) among physicians have evolved and extend beyond the notion of psychological distress caused by being in a situation in which one is constrained from acting on what one knows to be right. With many accounts involving complex personal, professional, legal, ethical and moral issues, we propose a review of current understanding of MD among physicians.

Methods: A systematic evidence-based approach guided systematic scoping review is proposed to map the current concepts of MD among physicians published in PubMed, Embase, PsycINFO, Web of Science, SCOPUS, ERIC and Google Scholar databases. Concurrent and independent thematic and direct content analysis (split approach) was conducted on included articles to enhance the reliability and transparency of the process. The themes and categories identified were combined using the jigsaw perspective to create domains that form the framework of the discussion that follows.

Results: A total of 30 156 abstracts were identified, 2473 full-text articles were reviewed and 128 articles were included. The five domains identified were as follows: (1) current concepts, (2) risk factors, (3) impact, (4) tools and (5) interventions.

Conclusions: Initial reviews suggest that MD involves conflicts within a physician's personal beliefs, values and principles (personal constructs) caused by personal, ethical, moral, contextual, professional and sociocultural factors. How these experiences are processed and reflected on and then integrated into the physician's personal constructs impacts their self-concepts of personhood and identity and can result in MD. The ring theory of personhood facilitates an appreciation of how new experiences create dissonance and resonance within personal constructs. These insights allow the forwarding of a new broader concept of MD and a personalised approach to assessing and treating MD. While further studies are required to test these findings, they offer a personalised means of supporting a physician's MD and preventing burn-out.

Keywords: education & training (see medical education & training); medical education & training; mental health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Ring theory of personhood.
Figure 2
Figure 2
SSR in SEBA process. SEBA, systematic evidence-based approach; SSR, systematic scoping review.
Figure 3
Figure 3
Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) flow chart.
Figure 4
Figure 4
Framework to understand MD. MD, moral distress.
See this image and copyright information in PMC

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