Moral Distress and Resilience Associated with Cancer Care Priority Setting in a Resource Limited Context

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Moral Distress and Resilience Associated with Cancer Care Priority Setting in a Resource Limited Context


JournalThe Oncologist
Article typeJournal research article – Clinical research
Publication date – May – 2021
Authors – Rebecca J. DeBoer , Espérance Mutoniwase , Cam Nguyen , Anita Ho , Grace Umutesi , Eugene Nkusi , Fidele Sebahungu , Katherine Van Loon , Lawrence N. Shulman , Cyprien Shyirambere
KeywordsCancer care, Developing Countries, LMICs, Research
Open access – Yes
SpecialityHealth policy, Surgical oncology
World region Global

Language – English
Submitted to the One Surgery Index on May 20, 2021 at 8:04 am
Abstract:

Background
Moral distress and burnout are highly prevalent among oncology clinicians. Research is needed to better understand how resource constraints and systemic inequalities contribute to moral distress in order to develop effective mitigation strategies. Oncology providers in low- and middle-income countries (LMICs) are well positioned to provide insight into the moral experience of cancer care priority setting and expertise to guide solutions.

Methods
Semi-structured interviews were conducted with a purposive sample of 22 oncology physicians, nurses, program leaders, and clinical advisors at a cancer center in Rwanda. Interviews were recorded, transcribed verbatim, and analyzed using the framework method.

Results
Participants identified sources of moral distress at three levels of engagement with resource prioritization: witnessing program-level resource constraints drive cancer disparities, implementing priority setting decisions into care of individual patients, and communicating with patients directly about resource prioritization implications. They recommended individual and organizational level interventions to foster resilience, such as communication skills training and mental health support for clinicians, interdisciplinary team-building, fair procedures for priority setting, and collective advocacy for resource expansion and equity.

Conclusion
This study adds to the current literature an in-depth examination of the impact of resource constraints and inequities on clinicians in a low resource setting. Effective interventions are urgently needed to address moral distress, reduce clinician burnout, and promote well-being among a critical but strained oncology workforce. Collective advocacy is concomitantly needed to address the structural forces that constrain resources unevenly and perpetuate disparities in cancer care and outcomes.

OSI Number – 21096

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