Clinical trial NCT06926296: Moral Injury in French Healthcare Workers
Official title: Moral Injury in French Healthcare Workers
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: NA
Conditions: Moral Injury
Keywords: Moral injury
Burnout
Depression
Anxiety
Healthcare workers
Health services research
Lead sponsor: Centre Hospitalier Intercommunal de Toulon La Seyne sur Mer
Sponsor class: OTHER
First posted: 2025-04-13
Enrollment: 3073
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Healthcare professionals are facing an escalating crisis, with burnout rates ranging between 40% and 60% and a growing intention to leave the profession, affecting one in five physicians and one in four nurses in the coming years. While current interventions focused on individual resilience, such as mindfulness, peer support, and workload management, have been promoted as solutions, they have failed to bring about systemic improvements. This raises the question of whether other factors, such as Moral Injury, play a key role in this crisis. Moral Injury is an emerging concept that highlights the profound misalignment between healthcare workers' professional values and the reality of their practice, often exacerbated by organizational and economic constraints.

The objective of this study is to describe the manifestations of Moral Injury among healthcare professionals in France. By establishing the first large-scale assessment of Moral Injury among healthcare professionals in France, this study aims to identify key organizational and personal risk factors contributing to this phenomenon. The use of Structural Equation Modeling will help build a robust theoretical model that clarifies the underlying mechanisms of Moral Injury and its interactions with broader health issues. The findings will support the development of targeted interventions focused on systemic organizational changes to improve healthcare workers' well-being and guide public health policies.

Detailed description: Healthcare professionals are facing an escalating crisis, with burnout rates ranging between 40% and 60% and a growing intention to leave the profession, affecting one in five physicians and one in four nurses in the coming years. While current interventions focused on individual resilience, such as mindfulness, peer support, and workload management, have been promoted as solutions, they have failed to bring about systemic improvements. This raises the question of whether other factors, such as Moral Injury, play a key role in this crisis. Moral Injury is an emerging concept that highlights the profound misalignment between healthcare workers' professional values and the reality of their practice, often exacerbated by organizational and economic constraints.

The primary objective of this study is to describe the manifestations of Moral Injury among healthcare professionals in France. Secondary objectives include the psychometric validation of a French-language Moral Injury scale, the analysis of organizational and individual determinants of Moral Injury, and the structural modeling of underlying mechanisms.

This nationwide cross-sectional survey will be conducted electronically, reaching participants through healthcare institutions, professional societies, social networks, and a snowball dissemination strategy. Data collection will include standardized scales such as the Moral Injury Inventory for Healthcare Professionals, the Moral Injury Events Scale (MIES), the Maslach Burnout Inventory (MBI), and the EuroQol 5-Dimensions (EQ-5D) for quality of life, as well as ad hoc questions designed to explore additional systemic and professional challenges. A rigorous psychometric validation of the Moral Injury scale will be performed, followed by Structural Equation Modeling (SEM) to analyze the complex relationships between Moral Injury and other factors such as burnout, depression, and anxiety.

By establishing the first large-scale assessment of Moral Injury among healthcare professionals in France, this study aims to identify key organizational and personal risk factors contributing to this phenomenon. The use of Structural Equation Modeling will help build a robust theoretical model that clarifies the underlying mechanisms of Moral Injury and its interactions with broader health issues. The findings will support the development of targeted interventions focused on systemic organizational changes to improve healthcare workers' well-being and guide public health policies.

Eligibility criteria: Inclusion Criteria:

* Healthcare workers

Exclusion Criteria:

* Absence of consent

Primary outcomes:
measure: Moral Injury Inventory for Healthcare Professionals
timeFrame: One point : baseline
Secondary outcomes:
measure: Moral Injury Events Scale
timeFrame: One point : baseline
measure: Maslach Burnout Inventory
timeFrame: One point : baseline
measure: EuroQol 5-Dimensions (EQ-5D)
timeFrame: One point : baseline
Other outcomes:
Locations:
city: Toulon
country: France
facility: Centre Hospitalier Intercommunal Toulon-La Seyne sur Mer
state: Var
Study officials:
affiliation: CEReSS
name: Laurent BOYER, Pr
role: STUDY_DIRECTOR
References:
citation: Boyer L, Fond G, Tran B, Llorca PM, Duclos A. The hidden crisis: Moral injury among French healthcare workers. J Epidemiol Popul Health. 2024 Dec;72(6):202780. doi: 10.1016/j.jeph.2024.202780. Epub 2024 Oct 19.
citation: Dean W, Morris D, Llorca PM, Talbot SG, Fond G, Duclos A, Boyer L. Moral Injury and the Global Health Workforce Crisis - Insights from an International Partnership. N Engl J Med. 2024 Sep 5;391(9):782-785. doi: 10.1056/NEJMp2402833. Epub 2024 Aug 31. No abstract available.