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Beyond burnout: professional grief and moral distress in pediatric neuro-oncological neurosurgery
Francesca Vitulli1, Maria Micucci2, Pietro Spennato1
11Neurosurgery Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, AORN, Naples.
Insights
Pediatric neuro-oncology professionals experience significant emotional burden and grief. Training and organizational support are crucial protective factors for healthcare workers in this demanding field.
Area of Science:
- Pediatric Neuro-Oncology
- Healthcare Professional Well-being
- Psychosocial Oncology
Background:
- Pediatric neuro-oncology presents unique challenges including high technical complexity, ethical dilemmas, and sustained emotional stress for healthcare professionals.
- Professional grief, moral distress, and second victim experiences are recognized issues in pediatric oncology but are under-researched in pediatric neuro-oncological neurosurgery.
Purpose of the Study:
- To characterize the experiences of professional grief, moral distress, and emotional impact among healthcare professionals in pediatric neuro-oncology.
- To assess the neuro-oncology-specific emotional burden and the level of organizational support perceived by these professionals.
Main Methods:
- A cross-sectional, anonymous survey was administered to healthcare professionals in pediatric neuro-oncology at a tertiary children's hospital.
- The survey assessed professional grief, moral distress, second victim/emotional impact, neuro-oncology-specific emotional burden, and organizational support using a 27-item questionnaire.
- The Pediatric Neuro-Oncology Professional Grief Score (PNOP-GS) was calculated, with descriptive statistics and internal consistency analyses performed.
Main Results:
- Forty-one responses were analyzed, with nurses and physicians forming the majority of participants; 87.8% had recent exposure to children with advanced or terminal brain tumors.
- The mean PNOP-GS was 91.2, with neuro-oncology-specific emotional burden and professional grief scoring highest, while organizational support was rated low.
- Prior training in palliative care or grief management was linked to lower emotional burden (p=0.002), whereas greater exposure to terminal cases correlated with higher PNOP-GS (p=0.049).
Conclusions:
- Healthcare professionals in pediatric neuro-oncology face substantial professional grief and emotional burden, influenced by ethical complexity and neurological morbidity.
- Neuro-oncology-specific emotional burden and professional grief are significant concerns, compounded by low perceived organizational support.
- Training in palliative care, communication, and grief management, alongside enhanced organizational support, are vital modifiable factors to mitigate emotional distress.
Objective:
Pediatric neuro-oncology exposes healthcare professionals to high technical complexity, ethical uncertainty, and sustained emotional stress. Professional grief, moral distress, and second victim experiences are increasingly recognized in pediatric oncology, yet they remain insufficiently characterized in pediatric neuro-oncological neurosurgery.
Methods:
The authors conducted a cross-sectional, anonymous survey among healthcare professionals involved in pediatric neuro-oncology at a tertiary children's hospital. A 27-item questionnaire assessed 5 domains: professional grief, moral distress, second victim/emotional impact, neuro-oncology-specific emotional burden, and organizational support. The Pediatric Neuro-Oncology Professional Grief Score (PNOP-GS; range 27-135) was calculated as the sum of all items. Descriptive statistics, internal consistency analyses, and exploratory comparisons by training and exposure were performed.
Results:
Forty-one complete responses were analyzed. Participants included nurses (46.3%), physicians (41.5%), and psychologists (9.8%), with 87.8% reporting exposure to children with advanced or terminal brain tumors in the preceding 12 months. The mean PNOP-GS was 91.2 ± 18.2, corresponding to a mean item score of 3.38 ± 0.67. Neuro-oncology-specific emotional burden (3.57 ± 0.96) and professional grief (3.42 ± 0.88) were the highest-scoring domains, while perceived organizational support was low (1.83 ± 0.78). Prior training in pediatric palliative care, communication of poor prognosis, or grief management was associated with significantly lower emotional burden (p = 0.002). Greater exposure to terminal cases correlated with higher PNOP-GSs (p = 0.049). Emotional burden did not differ significantly across professional roles. Internal consistency of the overall instrument was good (Cronbach's α = 0.82).
Conclusions:
Healthcare professionals in pediatric neuro-oncology experience substantial professional grief and emotional burden extending beyond patient death to ethical complexity and neurological morbidity. Training and organizational support represent modifiable protective factors and should be systematically integrated into pediatric neuro-oncological practice.
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