High Moral Distress in Clinicians Involved in the Care of Undocumented Immigrants Needing Dialysis in the United States

dc.contributor.authorJawed, Areeba
dc.contributor.authorMoe, Sharon M.
dc.contributor.authorAnderson, Melissa
dc.contributor.authorSlaven, James E.
dc.contributor.authorWocial, Lucia De.
dc.contributor.authorSaeed, Fahad
dc.contributor.authorTorke, Alexia M.
dc.contributor.departmentMedicine, School of Medicineen_US
dc.date.accessioned2023-01-18T16:43:28Z
dc.date.available2023-01-18T16:43:28Z
dc.date.issued2021-07-15
dc.description.abstractPurpose: To understand clinicians' perspectives on dialysis care of undocumented immigrants. Methods: A 21-item Internet-based survey using Survey Monkey® was sent to 765 physicians and nurses at a safety-net hospital located in Indianapolis, IN. Moral distress thermometer score was used to assess moral distress (MD). Participants were asked to rate their MD regarding five ethically challenging clinical situations: (1) frail patients with multiple comorbidities and poor quality of life, (2) patients with dementia, (3) a noncompliant patient with frequent emergency room (ER) visits, (4) violent patients with potential harm to others, and (5) undocumented immigrants receiving emergent dialysis only. Key Results: There were 299 of 775 participants (38.5% response rate) who completed the survey; 49.5% were physicians. Nearly half (48%) reported severe MD and 33% reported none to mild. In adjusted ordered logistic regression, females had significantly higher odds of MD (odds ratio [OR]=2.12, CI 1.03-4.33), and nurses had lower MD than fellows/residents (OR=0.14, CI 0.03-0.63). Over 70% of respondents attributed their distress to suffering of patients due to inadequate dialysis and tension between what is considered ethical and the law allows or forbids; 78% believed the patients' quality of life to be worse than those who receive routine hemodialysis. Among nephrologists, caring for these patients led to MD levels like that of dealing with a violent dialysis patient. Conclusions: Emergent-only dialysis causes significant MD in clinicians. Legal and fiscal policies need to be balanced with the ethical and moral commitments of providers for ensuring standard of care to all.en_US
dc.eprint.versionFinal published versionen_US
dc.identifier.citationJawed A, Moe SM, Anderson M, et al. High Moral Distress in Clinicians Involved in the Care of Undocumented Immigrants Needing Dialysis in the United States. Health Equity. 2021;5(1):484-492. Published 2021 Jul 15. doi:10.1089/heq.2020.0114en_US
dc.identifier.urihttps://hdl.handle.net/1805/30952
dc.language.isoen_USen_US
dc.publisherMary Ann Liebert, Inc.en_US
dc.relation.isversionof10.1089/heq.2020.0114en_US
dc.relation.journalHealth Equityen_US
dc.rightsAttribution 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.sourcePMCen_US
dc.subjectUndocumented immigrantsen_US
dc.subjectEthicsen_US
dc.subjectEmergent dialysisen_US
dc.subjectMoral distressen_US
dc.titleHigh Moral Distress in Clinicians Involved in the Care of Undocumented Immigrants Needing Dialysis in the United Statesen_US
dc.typeArticleen_US
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