Simple Interventions for Pediatric Residents' Moral Distress: A Randomized, Controlled Experiment

Abstract

Background and objectives: Pediatric residents are at high risk for moral distress, knowing the moral or ethically right thing to do but feeling unable to do it, which is associated with poor patient care and burnout. Researchers have proposed numerous interventions to reduce distress, but few (if any) have been supported by experimental evidence. In this study, we used an experimental method to provide proof-of-concept evidence regarding the effect of various simple supports on pediatric residents' reported degree of moral distress.

Methods: We conducted a study of pediatric residents using a split sample experimental design. The questionnaire contained 6 clinical vignettes describing scenarios expected to cause moral distress. For each case, participants were randomly assigned to see 1 of 2 versions that varied only regarding whether they included a supportive statement. After reading each of the 6 cases, participants reported their level of associated moral distress.

Results: Two hundred and twenty respondents from 5 residency programs completed the experiment. Cases were perceived to represent common scenarios that cause distress for pediatric residents. The addition of a supportive statement reduced moral distress in 4 of the 6 cases.

Conclusions: In this proof-of-concept study, simple yet effective interventions provided support by offering the resident empathy and shared perspective or responsibility. Interventions that were purely informational were not effective in reducing moral distress.

Figure 1:. Full Sample Case

Sample Case Vignette. This provides the full case describing a resident’s procedural distress. Half of residents saw the unsupported version; the remainder saw the supported version with an additional supportive statement by the supervising attending.

Figure 2:. CONsolidated Standards of Reporting Trials (CONSORT) Flow Diagram of the Experimental Study

This flow diagram displays the progress through the phases of sequential randomization into two groups for each case.

Figure 3:. Effect of Supports on Moral Distress

Primary Outcome Measures by Case. This matrix displays means and confidence intervals for the primary outcome measure, reported moral distress. For each case, responses are stratified by whether participants saw the unsupported or supported version of the case. CI= confidence interval