@article{TEXTUAL,
      recid = {13136},
      author = {Rivlin, Katherine and Bornstein, Marta and Wascher,  Jocelyn and Norris Turner, Abigail and Norris, Alison H.  and Howard, Dana},
      title = {State Abortion Policy and Moral Distress Among Clinicians  Providing Abortion After the <i>Dobbs</i>  Decision},
      journal = {JAMA Network Open},
      address = {2024-08-01},
      number = {TEXTUAL},
      abstract = {<p>Importance: Moral distress occurs when individuals feel  powerless to do what they think is right, including when  clinicians are prevented from providing health care they  deem necessary. The loss of federal protections for  abortion following the Dobbs v Jackson Women’s Health  Organization Supreme Court decision may place clinicians  providing abortion at risk of experiencing moral distress,  as many could face new legal and civil penalties for  providing care in line with professional standards and that  they perceive as necessary.</p> <p>Objective: To assess  self-reported moral distress scores among  abortion-providing clinicians following the Dobbs decision  overall and by state-level abortion policy.</p> <p>Design,  Setting, and Participants: This survey study, conducted  from May to December 2023, included US abortion-providing  clinicians (physicians, advanced practice clinicians, and  nurses). A purposive electronic survey was disseminated  nationally through professional listservs and snowball  sampling.</p> <p>Exposure: Abortion policy in each  respondent’s state of practice (restrictive vs protective  using classifications from the Guttmacher Institute).</p>  <p>Main Outcomes and Measures: Using descriptive statistics  and unadjusted and adjusted negative binomial regression  models, the association between self-reported moral  distress on the Moral Distress Thermometer (MDT), a  validated psychometric tool that scores moral distress from  0 (none) to 10 (worst possible), and state abortion policy  was examined.</p> <p>Results: Overall, 310 clinicians (271  [87.7%] women; mean [SD] age, 41.4 [9.7] years) completed  352 MDTs, with 206 responses (58.5%) from protective states  and 146 (41.5%) from restrictive states. Reported moral  distress scores ranged from 0 to 10 (median, 5) and were  more than double for clinicians in restrictive compared  with protective states (median, 8 [IQR, 6-9] vs 3 [IQR,  1-6]; P < .001). Respondents with higher moral distress  scores included physicians compared with advanced practice  clinicians (median, 6 [IQR, 3-8] vs 4 [IQR, 2-7];  P = .005), those practicing in free-standing abortion  clinics compared with those practicing in hospitals  (median, 6 [IQR, 3-8] vs 4 [IQR, 2-7]; P < .001), those no  longer providing abortion care compared with those still  providing abortion care (median, 8 [IQR, 4-9] vs 5 [IQR,  2-8]; P = .004), those practicing in loss states (states  with the greatest decline in abortion volume since the  Dobbs decision) compared with those in stable states  (unadjusted incidence rate [IRR], 1.72 [95% CI, 1.55-1.92];  P < .001; adjusted IRR, 1.59 [95% CI, 1.40-1.79];  P < .001), and those practicing in surge states (states  with the greatest increase in abortion volume since the  Dobbs decision) compared with those in stable states  (unadjusted IRR, 1.27 [95% CI, 1.11-1.46]; P < .001;  adjusted IRR, 1.24 [95% CI, 1.09-1.41]; P = .001).</p>  <p>Conclusions and Relevance: In this purposive national  survey study of clinicians providing abortion, moral  distress was elevated among all clinicians and more than  twice as high among those practicing in states that  restrict abortion compared with those in states that  protect abortion. The findings suggest that structural  changes addressing bans on necessary health care, such as  federal protections for abortion, are needed at  institutional, state, and federal policy levels to combat  widespread moral distress.</p>},
      url = {http://knowledge.uchicago.edu/record/13136},
}