Moral distress measurement in animal care workers: a systematic review.

OBJECTIVES: The mental health of veterinary and other animal health professionals is significantly impacted by the psychological stressors they encounter, such as euthanasia, witnessing animal suffering and moral distress. Moral distress, initially identified in nursing, arises when individuals are aware of the right action but are hindered by institutional constraints. We aimed to review existing research on moral distress scales among animal care workers by focusing on the identification and psychometric validity of its measurement. DESIGN: Two-step systematic review. First, we identified all moral distress scales used in animal care research in the eligible original studies. Second, we evaluated their psychometric validity, emphasising content validity, which is a critical aspect of patient-reported outcome measures (PROMs). This evaluation adhered to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). The results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. DATA SOURCES: PubMed, EMBASE and PsycINFO to search for eligible studies published between January 1984 and April 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included original (primary) studies that (1) were conducted in animal care workers; (2) describing either the development of a moral distress scale, or validation of a moral distress scale in its original or modified version, to assess at least one of the psychometric properties mentioned in COSMIN guidelines. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers used standardised methods to search, screen and code included studies. We considered the following information relevant for extraction: study reference, name and reference of the moral distress scale used, psychometric properties assessed and methods and results of their assessments. The collected information was then summarised in a narrative synthesis. RESULTS: The review identified only one PROM specifically adapted for veterinary contexts: the Measure of Moral Distress for Animal Professionals (MMD-AP), derived from the Measure of Moral Distress for Healthcare Professionals (MMD-HP). Both MMD-HP and MMD-AP were evaluated for the quality of development and content validity. The development quality of both measures was deemed doubtful. According to COSMIN, MMD-HP's content validity was rated as sufficient, whereas MMD-AP's was inconsistent. However, the evidence quality for both PROMs was rated low. CONCLUSION: This is the first systematic review focused on moral distress measurement in animal care workers. It shows that moral distress is rarely measured using standardised and evidence-based methods and that such methods should be developed and validated in the context of animal care. PROSPERO REGISTRATION NUMBER: CRD42023422259.

Measurement of compassion fatigue in animal health care professionals: a systematic review of available instruments and their content validity.

Introduction: Compassion fatigue (CF) refers to emotional or physical exhaustion and emotional reactions resulting from prolonged exposure to traumatic events, commonly experienced by professionals in caregiving roles. CF is prevalent among healthcare professionals, including those in animal care. Several Patient-Reported Outcome Measures (PROMs) were developed to measure CF, but their psychometric validity was not reviewed systematically. This study aims to identify and review the content validity of CF PROMs used in animal health care professionals. Methods: Literature was searched in PubMed, PsycINFO, and EMBASE (1973-2023). We included studies conducted in animal health care professionals, using a PROM to measure CF, reporting at least one psychometric property of this PROM, and published as original research. For each identified PROM, additional literature search was conducted to identify PROM development and content validation studies. Three independent reviewers evaluated the content validity of each PROM using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology and summarized the quality of evidence using a modified GRADE approach. The protocol was registered in PROSPERO (CRD42023433982) and results reported following PRISMA guidelines. Results: Initially, 1709 studies were identified. After a double screening, 17 eligible studies were included. CF was measured using six different PROMs or their modified versions. Only one PROM specifically targeted animal health care professionals: the ProQOL-5 Veterinary Medicine Version. This and three other original CF PROMs were reviewed. For all PROMs, the quality of content validity was rated as insufficient due to deficiencies in the concept and items elicitation, inadequate target population representation, and inadequate details on cognitive interview procedures. The overall evidence quality was rated as low due to a limited number of PROM validation studies, poor methodological and reporting quality, and indirect result. Discussion: There is a scarcity of studies examining CF within the target population, and the quality of evidence for content validity of the reviewed PROMs for CF measurement is currently low. CF definition and construct description in PROM development studies suffer from vagueness and seem inadequately reflected by the content of the reviewed PROMs. Further research with a robust methodology seems necessary to address the identified flows. Systematic review registration: Measurement of compassion fatigue in people working with animals: protocol for a systematic review. PROSPERO 2023 CRD42023433982. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023433982.