Project title
Impact of moral distress and death and dying on physicians in Singapore
Country
Singapore
Background
Consistent exposure to moral distress impairs a physician’s quality of life, personal and professional identity, heightens the risk of burnout and maladaptive coping strategies, impairs clinical decision-making, and hampers interprofessional interactions that compromise overall patient care. Perhaps one of the most common sources of moral distress is caring for dying patients. Our reviews on moral distress, and the impact of death and dying, reveal that when unsupported, these experiences undermine a physician’s ability to provide personalised, holistic, and patient-centred care.
Our reviews also suggest that a better understanding of how physicians cope is possible by charting changes in their self-concept of personhood or “what makes you, you”. To this end, we apply the Ring Theory of Personhood (RToP) to interviews with clinicians in order to map coping and maladaptation. To sketch the spectrum of coping responses, we invite palliative care, oncologists, renal physicians, and emergency physicians who care for those facing end of life, from sudden death to death following chronic illness. We believe that this will aid us in informing efforts to shape educational and support mechanisms to help physicians in these fields and beyond.
Summary
RToP-guided semi-structured interviews with oncologists, palliative care, renal physicians, and emergency physicians caring for the dying will guide better individual support and shape the general training of physicians in these fields and beyond.
Outcome
This research aims to provide a holistic understanding of how caring for dying patients affects physicians, and provide clarity on their experiences, support for their coping mechanisms, and guide the design of educational initiatives to support and improve the wellbeing, coping, and efficacy of physicians working in this space and beyond.
Initial findings from this research have been published in:
Somasundaram, N., Ibrahim, H., Govindasamy, R. et al. Caring for terminally Ill patients: the impact on oncologists. BMC Palliat Care 23, 231 (2024). https://doi.org/10.1186/s12904-024-01562-9
Sinnathamby A, Ong YT, Lim SX, et al. Concepts of Suffering at the End of Life Amongst Emergency, Palliative Care and Geriatric Medicine Physicians in Malaysia. American Journal of Hospice and Palliative Medicine®. 2025;0(0). https://journals.sagepub.com/doi/10.1177/10499091251317725
BMC Surgery (print and online): The impact of death and caring for the dying and their families on surgeons - an AI assisted systematic scoping review | BMC Surgery | Full Text
American Journal of Hospice and Palliative Medicine® (print and online): Moral Distress and the Cost of Caring Amongst Medical Oncologists in Singapore - Varsha Rajalingam, Yutian Yu, Yun Ting Ong, Annushkha Sinnathamby, Nila Ravindran, Nagavalli Somasundaram, Simon Yew Kuang Ong, Lalit Kumar Radha Krishna, 2025
Somasundaram, N., Ibrahim, H., Govindasamy, R. et al. Caring for terminally Ill patients: the impact on oncologists. BMC Palliat Care 23, 231 (2024). https://doi.org/10.1186/s12904-024-01562-9 Caring for terminally Ill patients: the impact on oncologists | BMC Palliative Care | Springer Nature Link
Radha Krishna, L.K., Binte Abdul Hamid, N.A., Lim, NA. et al. Journeying with the Dying—Lessons from Palliative Care Physicians. ABR 17, 591–613 (2025). https://doi.org/10.1007/s41649-024-00321-5 Journeying with the Dying—Lessons from Palliative Care Physicians | Asian Bioethics Review | Springer Nature Link
Ong YT, Sinnathamby A, Tan JH, Ravindran N, Lim SX, Hiew AWH, Ng SY, Ong SYK, Krishna LKR. Towards a Clinically Relevant Appreciation of the Cost of Caring: A Study of Palliative Care Physicians in Malaysia. Am J Hosp Palliat Care. 2025 Dec;42(12):1234-1243. doi: 10.1177/10499091241298281. Epub 2024 Nov 7. PMID: 39508141. Towards a Clinically Relevant Appreciation of the Cost of Caring: A Study of Palliative Care Physicians in Malaysia - PubMed
Shin Wei Sim, Lalit Kumar Radha Krishna, Gerard Porter, Saying ‘I’m sorry’ at the bedside: when and why should apologies following medical mishaps be protected from legal liability?, Medical Law Review, Volume 33, Issue 1, Winter 2025, fwaf011. Saying ‘I’m sorry’ at the bedside: when and why should apologies following medical mishaps be protected from legal liability? | Medical Law Review | Oxford Academic