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Moral Distress in Pediatric Palliative Care: A Cross-Sectional Study with Brazilian Professionals
Julianna Rodrigues Beltrão1, Kelly Sales Zem1, Luana da Rocha Celli1
1Pontifícia Universidade Católica do Paraná, Curitiba, Brasil.
Insights
Moral distress is common for healthcare professionals in pediatric palliative care (PPC). Communication issues, like false hope and poor team communication, significantly increase this distress, impacting professional well-being and care quality.
Area of Science:
- Medical Ethics
- Palliative Care
- Healthcare Professional Well-being
Background:
- Bioethical conflicts and moral distress are prevalent among healthcare professionals caring for critically ill children.
- In pediatric palliative care (PPC), moral distress can negatively affect both professional well-being and the quality of care delivered.
- Understanding the factors contributing to moral distress is crucial for developing supportive interventions.
Purpose of the Study:
- To analyze the prevalence and identify factors associated with moral distress among healthcare professionals in pediatric palliative care.
- To investigate the relationship between professional roles, experience, and moral distress levels within PPC teams.
Main Methods:
- A cross-sectional study was conducted using the Measure of Moral Distress for Healthcare Professionals - Brazilian Version (MMD-HP BR) scale.
- The online survey was administered to 112 professionals working in pediatric palliative care settings.
- Data analysis included descriptive statistics and correlation analysis to identify significant associations.
Main Results:
- The average moral distress score was 104.2 (±74.8), with significant variations across different professions.
- Nursing technicians reported lower distress compared to nurses, physiotherapists, physicians, and psychologists.
- Professionals considering job changes due to distress reported higher moral distress scores.
- Key contributors to distress included observing healthcare professionals giving false hope and experiencing poor team communication.
Conclusions:
- Moral distress in pediatric palliative care is significantly linked to communication challenges within the healthcare team.
- Addressing communication breakdowns and providing support are essential for mitigating moral distress and enhancing professional well-being.
- Further research is needed, particularly in the Brazilian pediatric context, to develop targeted support strategies.
Abstract:
IntroductionHealthcare professionals caring for children with life-threatening illnesses face frequent bioethical conflicts, often leading to moral distress. In pediatric palliative care (PPC), this can compromise both professional well-being and quality of care.ObjectiveTo analyze moral distress among professionals in PPC and identify associated factors.MethodCross-sectional study using the Measure of Moral Distress for Healthcare Professionals - Brazilian Version (MMD-HP BR) scale, applied online to PPC professionals.ResultsA total of 112 professionals participated, mean age 41 years (±9.1), predominantly female (90.2%) and from the Southeast region (49%). Average professional experience was 15 years (±9.2), with 6 years (±4.3) in PPC. Most participants were physicians (55.4%) and nurses (13.4%). The mean MMD-HP BR score was 104.2 (±74.8), significantly correlated with profession (P = 0.045). Nursing technicians had lower distress compared to nurses (P = 0.014), physiotherapists (P = 0.02), physicians (P = 0.002) and psychologists (P = 0.014). Higher scores were found among professionals who had considered leaving, had left, or were considering leaving their jobs. The most impactful items were: "I observe health professionals communicating 'false hopes' to the patient or family" and "I observe poor quality care due to lack of communication between team members".ConclusionMoral distress in PPC is strongly linked to communication difficulties, a critical factor in professionals' experiences. The scarcity of studies in pediatrics, especially in Brazil, highlights the need for further research to develop strategies that support team well-being and improve the quality of care provided to children and families.
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