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. 2023 Dec;53(4):239-246.
doi: 10.1177/14782715231203941. Epub 2023 Oct 24.

Out-of-hours decision-making in deteriorating patients by foundation year doctors: Relationship to moral distress

Justin C Geddes  1 , Margaret MacDougall  2 , Robin D Taylor  3
Affiliations

Out-of-hours decision-making in deteriorating patients by foundation year doctors: Relationship to moral distress

Justin C Geddes et al. J R Coll Physicians Edinb. 2023 Dec.

Abstract

Background: Moral distress (MD) refers to psychological unease when healthcare professionals identify morally correct actions to take but are constrained in their ability to take those actions.

Methods: This study evaluated the relationship between out-of-hours decisions and MD among 40 Foundation Year 2 (FY2) doctors. They were asked to choose the 'expected' and the 'right' management options for five out-of-hours scenarios and complete an adapted Measure of Moral Distress for Health Professionals (MMD-HP) questionnaire.

Results: 28/40 (70%) reported discordance between 'expected' and 'right' options more frequently than concordance. The mean total MMD-HP score was low: 64.9 (SD = 26.9), range 13-143, maximum 288. The association between decision-making discordance and MMD-HP score was weak.

Conclusion: Out-of-hours decisions by FY2 doctors were characterised by doing what is 'expected' rather than what is perceived to be 'right'. Providing guidance regarding decision-making in deteriorating patients is needed for patient safety and staff well-being.

Keywords: deteriorating patient; health psychology; medical decision-making; moral distress; trainee doctors.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

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