title: Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study.
abstract: BACKGROUND
  Ethical challenges are common in end of life care; the uncertainty of prognosis and the ethically permissible boundaries of treatment create confusion and conflict about the balance between benefits and burdens experienced by patients.
  
  
  OBJECTIVE
  We asked physician trainees in internal medicine how they reacted and responded to ethical challenges arising in the context of perceived futile treatments at the end of life and how these challenges contribute to moral distress.
  
  
  METHODS
  Semi-structured in-depth qualitative interviews.
  
  
  METHODS
  Twenty-two internal medicine residents and fellows across three American academic medical centers.
  
  
  METHODS
  This study uses systematic qualitative methods of data gathering, analysis and interpretation.
  
  
  RESULTS
  Physician trainees experienced significant moral distress when they felt obligated to provide treatments at or near the end of life that they believed to be futile. Some trainees developed detached and dehumanizing attitudes towards patients as a coping mechanism, which may contribute to a loss of empathy. Successful coping strategies included formal and informal conversations with colleagues and superiors about the emotional and ethical challenges of providing care at the end of life.
  
  
  CONCLUSIONS
  Moral distress amongst physician trainees may occur when they feel obligated to provide treatments at the end of life that they believe to be futile or harmful.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, USA. elizabeth.dzeng@ucsf.edu.|Program in Palliative Care, Johns Hopkins School of Medicine, Baltimore, USA. elizabeth.dzeng@ucsf.edu.|Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. elizabeth.dzeng@ucsf.edu.|Department of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA. elizabeth.dzeng@ucsf.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dzeng
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, USA.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Colaianni
authors.affiliation: Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Roland
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, USA.
authors.forename: David
authors.initials: D
authors.lastname: Levine
authors.affiliation: Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kelly
authors.affiliation: Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Barclay
authors.affiliation: Program in Palliative Care, Johns Hopkins School of Medicine, Baltimore, USA.|Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D018447:Medical Futility / Q000523:psychology*; D009014:Morals; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research; D013315:Stress, Psychological / Q000523:psychology*; D013727:Terminal Care / Q000941:ethics*; D014481:United States