Prevalence and Risk Factors of Moral Distress Among Surgeons Specialized in Oncology Care

BACKGROUND: Moral distress, the negative emotions associated with the inability to do the right thing due to imposed constraints, is prevalent among health care workers but underexplored among surgeons. METHODS: This was a cross-sectional study in October 2024 using the Measure of Moral Distress for Healthcare Professionals (MMD-HP) survey distributed to the Division of Surgery at a comprehensive cancer center. Descriptive statistics as well as Mann-Whitney U, Kruskal-Wallis, and Fisher's exact tests were used to compare group differences. RESULTS: The overall response rate was 19.3 % (45/233). Among the respondents, 48.9 % were female (n = 22), 24.4 % were racial and ethnic minorities % (n = 11), and 28.9 % were trainees (n = 13). The top surgical specialties included surgical oncology (n = 22, 48.9 %), breast surgical oncology (n = 7, 15.6 %), and gynecologic oncology (n = 8, 17.8 %). Of the respondents, 28.9 % (n = 13) practiced in an acute/intensive care setting, and 26.7 % (n = 12) received previous palliative care training. All the respondents reported moral distress (median, MMD-HP score, 61; interquartile range [IQR], 33-86). Because of moral distress, 24 % (n = 11) considered leaving or had left a clinical position, and 8.9 % (4) considered leaving their current position. Those who intended to leave had significantly higher scores than those who did not (p < 0.05). The MMD-HP scores did not differ significantly by demographics, trainee versus faculty role, surgical subspecialty, or palliative care experience. The top sources of moral distress centered around patient- and team-level interactions. CONCLUSION: In this cohort of surgeons specialized in oncology care, moral distress was highly prevalent and driven by patient-, team-, and system-level factors. These findings may help inform the development of interventions aimed at mitigating moral distress for current and future generations of surgeons.