Response:

We thank Flaherty and colleagues for their interest in our work. We address the questions posed below:

Although higher response rates are obviously ideal, the response rate in our study was comparable to that of similar studies.^1,2  Although we do not have objective data to elucidate why response rates may have been lower than desired, anecdotally, several respondents voluntarily approached members of the study team to discuss how difficult it was to fill out the survey. In these exchanges, participants described the experience as “triggering” and reported that it took them multiple attempts to complete the survey. Whether this phenomenon was widespread and could have substantially contributed to nonresponse is unclear, although it highlights how impactful moral distress can be on clinicians. With regards to coding of missing data as 0, this occurred in only 2 participants on the “level of disturbance” portion of a question for...