Moral distress amongst palliative care doctors working during the COVID-19 pandemic: A narrative-focussed interview study

Moral distress amongst palliative care doctors working during the COVID-19 pandemic: A narrative-focussed interview study

Background: Palliative care professionals have had to adapt to rapidly changing COVID-19 restrictions with personal protective equipment and physical distancing measures impacting face-to-face communication with patients and relatives. Aim: To explore the narratives of palliative care doctors workin...

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Bibliographic Details
Published in:Palliative medicine Vol. 36; no. 6; pp. 955 - 963
Main Authors: Fish, Ellis C., Lloyd, Anna
Format: Journal Article
Language:English
Published: London, England SAGE Publications 01-06-2022
Sage Publications Ltd
Subjects:
Coronaviruses
COVID-19
Emotional distress
Hospice care
Hospices
Inpatient care
Interviews
Moral injury
Morale
Narratives
Occupational stress
Original
Palliative care
Pandemics
Patient communication
Physicians
Proximity
Psychological distress
COVID-19
hospice care
moral distress
communication
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Summary:Background: Palliative care professionals have had to adapt to rapidly changing COVID-19 restrictions with personal protective equipment and physical distancing measures impacting face-to-face communication with patients and relatives. Aim: To explore the narratives of palliative care doctors working during the pandemic to understand their experiences at a personal and professional level. Design: In-depth narrative interviews were carried out via video call. Interviews were transcribed verbatim and analysed using a joint paradigmatic and narrative approach to elucidate common themes and closely explore individual narratives. Setting/participants: Eight palliative care doctors who had worked on a hospice inpatient unit in the UK before and during the pandemic were recruited from two hospices in Scotland. Results: Three intersecting themes are described, the most significant being moral distress. Participants articulated a struggle to reconcile their moral convictions with the restrictions enforced, for example, wanting to provide support to patients through physical proximity but being unable to. To differing degrees, this resulted in internal conflict and emotional distress. Two further themes arose: the first concerned a loss of humanity in interaction and a striving to re-humanise communication through alternative means; the second being a change in staff morale as the pandemic progressed. Conclusions: Restrictions had a considerable impact on palliative care doctors’ ability to communicate with and comfort patients which led to moral distress and contributed to decreasing morale. Future research could explore moral distress in palliative care settings internationally during the pandemic with a view to compare the factors affecting how moral distress was experienced.
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ISSN:0269-2163
1477-030X
DOI:10.1177/02692163221088930