PP24.001 A narrative literature review of moral distress experienced by ACP facilitators and frontline clinicians

• Published in: BMJ supportive & palliative care Vol. 13; no. Suppl 4; p. A50
• Main Authors: Goh, Siew Fong, Yu, Chou Chuen, Tang, Jia Ying, Yiew Hock Low, James Alvin, Ng, Chong Jin, Cruz, Maria Teresa, Chong, Roland, Yan Kathleen Cheung, Ka, Hau Yan Ho, Andy, Menon, Sumytra, Ng, Raymond
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 22.05.2023; BMJ Publishing Group LTD
• Subjects: Advance directives; Decision making; Ethics; Literature reviews; Medical personnel; Palliative care; Poster Abstracts; Professionals
• ISSN: 2045-435X; 2045-4368
• DOI: 10.1136/spcare-2023-ACP.125

BackgroundSince 2011, the Respecting Choices framework of Advance Care Planning (ACP) has been rapidly implemented as a nationwide programme named Living Matters in Singapore. Despite numerous trained ACP facilitators and documentations completed, anecdotally, there were reports of strain in inter-professional teamwork in the ACP process, moral distress of ACP facilitators as well as healthcare providers at point of care and ethical conundrums faced. As part of an empirical study on moral distress and coping of healthcare professionals in ACP, a narrative review was first undertaken to investigate on this topic.MethodsxLiterature relating to moral distress among ACP facilitators and frontline clinicians was systematically retrieved from PubMed, using keywords search as such Advance Care Planning, ethical dilemmas, ethical considerations, ethical conflicts, surrogate decision making, Moral Distress, Decision making. We included original studies, case studies, reviews and expert opinion pieces on the topic from 2011 to 2021 and excluded articles written in other languages than English.ResultsResearch in moral distress is limited mainly to case reports and opinion pieces. Sources of moral distress were purported to arise from discordance in views amongst healthcare professionals, patients and/or family caregivers in the following contexts: goals of care; operationalization of preferences; changes in preferences; professional responsibilities; definition of best interest; purpose of ACP facilitation; type of subjects to broach; choice of narratives; sources to incorporate in ACP discussion; interpretation of personhood of the patient; types of recommendations to adopt; understanding of risks; range of outcomes; temporal priority of preferences; ethical and moral values; content for documentation. There are no studies examining adaptive coping of clinicians in ACP work.ConclusionReview established the lack of empirical research on the extent and depth of moral distress and future studies are needed to elucidate this construct and also adaptive coping of clinicians in ACP.