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

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.