BACKGROUND:
Advanced practice providers, particularly midwives, have described significant ethical conflict when making drug testing and child welfare reporting decisions for their maternity patients with opioid use disorder (OUD). Ethical conflict in clinical practice is associated with provider burnout and poor patient outcomes. However, provider and policy factors underlying this specific ethical conflict have not been empirically explored.

OBJECTIVES:
The purpose of this study was to characterize the influence of provider and policy factors on the ethical conflict experienced by advanced practice providers (APPs; midwives, nurse practitioners, physician associates) in the United States (US) related to drug testing and reporting for maternity patients with OUD.

METHODS:
APPs across the US (N=171) completed a cross-sectional survey, adapted from Falcó-Pegueroles’ Ethical Conflict in Nursing Questionnaire, to measure exposure (frequency x intensity) to ethical conflict in clinical scenarios about drug testing and reporting for maternity patients with OUD (α= .84). General linear regression modeling was employed with ethical conflict regressed on provider (stigma and moral sensitivity) and policy (state laws and institutional practices) predictors, adjusting for relevant demographic covariates.

RESULTS:
All participants were female, and 64.3% were midwives. Most were white (86%) and were well-represented across US regions. Higher provider stigma towards maternity patients with OUD predicted lower overall ethical conflict exposure (p=0.02). Discretionary drug testing practices predicted higher overall ethical conflict exposure (p=0.03) when compared to universal drug testing practices. The differential effect of state laws across scenarios reflects the legal-ethical interplay between maternal and child considerations.

CONCLUSIONS:
Stigma-reduction training and changes to testing and reporting policies must concurrently address ethical conflict experienced by APPs.

KEY MESSAGE:
APPs are essential players in delivering high-quality, non-stigmatizing care to dyads impacted by OUD. Clarifying predictors of APPs’ ethical conflict over testing and reporting decisions is necessary to improve care for these vulnerable patients. Poster session 4 (Group B)