Digital Interventions to Reduce Moral Distress Among Frontline Health Care Providers: A Feasibility Trial (Preprint)

Abstract

The COVID-19 pandemic has challenged the mental health of healthcare workers, increasing the rates of moral distress (MD) and moral injury (MI) in this population.

This pilot study aimed to investigate the feasibility of a virtual reality (VR) scenario to examine MD among healthcare workers during COVID-19, and to use our mobile application for real-time longitudinal monitoring of stress, MD, and MI in the eight weeks following the VR scenario.

Participants were immersed in a VR scenario consisting of a morally challenging situation related to shortage of life-saving equipment in the COVID-19 pandemic. During the scenario participants answered the Moral Injury Outcome Scale (MIOS), the Perceived Stress Scale (PSS) and had their physiological signals collected. After the scenario, we conducted a debriefing session to gather participants’ impressions and feelings of the experiment and performed content analysis. Participants were also instructed to use a mobile application for the following eight weeks for monitoring stress, MD, and mental health symptoms. We conducted Wilcoxon signed-rank tests on the PSS and MIOS scores to examine if the VR scenario could induce significant stress and MD. Additionally, we evaluated user experience and the sense of presence at the end of the scenario through semi-open-ended feedback and the Igroup Presence Questionnaire (IPQ), respectively. The qualitative feedback was summarized and categorized to offer an experiential perspective. We used PSS and MIOS scores and physiological signals collected during the VR scenario to create a data-driven machine learning model to evaluate MD. MIOS scores were clustered into respective severities using a support vector machine to classify MD.

There were no dropouts during the VR scenario. Statistical analyses revealed no significant difference in the MIOS and PSS scores between before and after the experiment (P=.11 and P=.22, respectively), suggesting that the experiment did not acutely induce significant levels of stress or MD. On the other hand, the content analysis revealed feelings of guilt, shame, and numbness, which corresponded to the experience of MD. Based on IPQ results, the VR scenario achieved an above average degree of overall presence, spatial presence, and involvement, and slightly below average realism. The classification model achieved an accuracy of 98.67±0.87% for classifying MD. Over half of the participants did not answer symptom surveys on the mobile app.

Our study demonstrated VR to be a feasible method to simulate the experience of morally challenging events and elicit genuine responses associated with MD, with high acceptability and tolerability. Future research could better define its efficacy in examining stress, MD, and MI both acutely and in the longer term. An improved participant strategy for mobile data capture is needed for future studies.

ClinicalTrials.gov NCT05001542

RR2-10.2196/32240