The moral middle ground: How moral distress mediates the link between patient-centered communication and palliative...

Oncology nurses face significant emotional and ethical challenges, particularly in delivering palliative care. While patient-centered communication (PCC) is essential for high-quality end-of-life care, its effectiveness may be hindered by moral distress-a psychological response to institutional or ethical constraints. This study examines how moral distress mediates the relationship between patient-centered communication and palliative care competence among oncology nurses.

A cross-sectional survey was conducted with 200 oncology nurses from four oncology centers across Egypt. Validated instruments were used to assess PCC, moral distress, and self-perceived palliative caring competence. Data were analyzed using correlation, multiple regression, and mediation analysis via Hayes' PROCESS macro.

PCC was positively associated with palliative caring competence (r = .483, p < .001) and negatively associated with moral distress (r = -.290, p < .001). Moral distress was inversely correlated with palliative caring competence (r = -.460, p < .001). Mediation analysis confirmed that moral distress partially mediated the relationship between PCC and competence (indirect effect = .101, 95 % CI [.054-.148]).

Moral distress is a significant psychological barrier that weakens the positive impact of patient-centered communication on oncology nurses' ability to deliver competent palliative care. Regulatory bodies and healthcare organizations should prioritize ethical support systems, communication training, and workload reform to mitigate moral distress and strengthen palliative care competence among nurses. Addressing these factors is vital to enhancing care quality and workforce sustainability in oncology settings.