"Between Universes:" Moral Distress in Delivering Culturally Attuned Care to South Asian Breast Cancer Survivors.

Context: Even as health care institutions seek to promote culturally attuned care, clinicians may struggle when cultural norms and practices contradict established clinical practices.

Objectives: To explore sources of moral distress among clinicians treating the growing population of South Asian breast cancer survivors.

Methods: We report secondary analyses from a mixed methods study that aimed to understand the barriers and facilitators to providing culturally attuned care to South Asian breast cancer survivors. We conducted 30-minute virtual semi-structured interviews with multidisciplinary clinicians involved in cancer care. Interviews were guided by the Consolidated Framework of Implementation Research (CFIR). For this study, we used a thematic analysis approach to examine the sources of moral distress, and potential solutions to address it.

Results: 14 clinicians (8 physicians; 41.6±9.8 years; 9 women; 4 South Asian) were interviewed. We identified the following themes: 1) Clinicians experienced moral distress when South Asian cultural norms conflicted with pillars of biomedical ethics; 2) Moral distress was exacerbated by individual and system-level barriers; and, 3) Solutions may necessitate change across individual, inner setting (e.g., clinics), and outer setting (e.g., health care systems) domains of CFIR.

Conclusions: Clinicians may experience moral distress when their evidence-based and ethical care approaches conflict with cultural norms. Health care systems should provide programs that support clinicians who encounter these dilemmas to ensure high quality clinical care that respects the cultural norms of South Asian breast cancer survivors.