Physicians often experience significant moral distress when caring for elders who cannot participate in decision-making, say the authors of a new study. Communication, including through an advance directive, is key to easing the problem, they found.
Moral distress occurs when the ethically correct action to take differs from what a provider is tasked with doing. About four in 10 doctors experience this problem when caring for older adults who require a surrogate decision-maker, reported scientist Alexia Torke, M.D., from the Regenstrief Institute, Indianapolis.
One of the biggest contributors to this feeling are care plans that include more life-sustaining treatment for the patient than the physician believes is appropriate, wrote Torke. But the odds of distress lessened when physicians learned that patients’ wishes were clearly outlined before they became cognitively impaired, the authors added.
“Physician moral distress was lower when the patient had expressed his or her preferences through an advance medical directive or even orally … and these preferences were made known to the treating physician,” said nurse ethicist Lucia Wocial, Ph.D., R.N., from Indiana University Health.
Notably, physicians were also less likely to experience moral distress when caring for nursing home residents. The study did not delve into the reasons behind this particular finding, however.
