High prevalence of moral distress reported by oncologists and oncology nurses in end-of-life decision making
Menée en Allemagne par enquête auprès de 51 médecins et 67 infirmières en oncologie s'occupant de 100 patients atteints d'un cancer de stade avancé en fin de vie, cette étude analyse la présence et l'intensité de leur détresse morale lors de la prise de décisions visant à limiter la durée des traitements
Objective : Decisions to limit life-prolonging treatment (DLT) are often accompanied by psychological and ethical difficulties. The aim of the study is to investigate prevalence and intensity of moral distress (MD) as well as potential causes experienced by oncology physicians and nurses in DLT situations. Methods : This prospective study at a German university hospital included n=100 advanced cancer inpatients with DLT. We surveyed their respective physicians and nurses to assess moral distress (MD) in DLT using an adapted distress thermometer and an open-ended question to specify reasons of MD. We also collected data on the decision-making process from the perspective of the clinicians. Results : Physicians report MD in 67% (n=51) and nurses in 74% (n=67) of the cases. The MD-level (MDL) in nurses (mean 2.3; SD 2.3) is significantly higher (p=.005) than in physicians (mean 1.5; SD 1.4). Uncertainties concerning ethical aspects in DLT in a patient case are associated with moral distress in both physicians (p=.024) and nurses (p=.004). Involvement of nurses in DLT is the strongest predictor (p=.000) for moral distress as indicated by physicians. Nurses experience MD especially, if the patient has a low quality of life (p=.001). Conclusions : MD is experienced by both oncologists and nurses in DLT. Nurses report higher MD intensity compared to physicians although the ultimate responsibility for DLT lies with the physicians. Support for the challenging decisions may be provided through the implementation of an ethical guideline and enhanced interprofessional communication.