Moral distress amongst palliative care doctors working during the COVID-19 pandemic: A narrative-focussed interview study
Open accessAbstract
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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Staff caring for people with an advanced progressive illness are at risk of stress, distress and burnout.
“Staff caring for people with an advanced progressive illness are at risk of stress, distress and burnout.”
From Acceptance and Commitment Therapy (ACT) for people with advanced progressive illness, their caregivers and staff involved in their care: A scoping review. (2023) · cites this paper as [17]
The Introduction reports anxiety and psychological distress among palliative-care workers during COVID-19. The Discussion sections on moral distress and mental wellbeing describe doctors’ vulnerability to stress and a risk of professional burnout. The claim extends these pandemic-specific findings about palliative-care workers, particularly doctors, to staff caring for people with advanced progressive illness generally. (LLM, conf=0.84)
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- Authors
- Fish, E. C., & Lloyd, A.
- Affiliations
- University of Edinburgh (GB)
- St Columba’s Hospice, Education and Research, Edinburgh, UK
- Corresponding author
- Fish, Ellis C.
- Venue
- Palliative Medicine
- Publisher
- SAGE Publications
- Published
- 2022-05-12
- Volume
- 36
- Issue
- 6
- Pages
- 955-963
- ISSN
- 0269-2163 (ISSN-L)
- 1477-030X
- PMC
- PMC9174577
- OpenAlex
- W4280491658
- Cited by
- 20
- References
- 30
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 7 · 2023: 8 · 2022: 1
- FWCI
- 5.45
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Palliative Medicine (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- moral distress, COVID-19 pandemic, personal protective equipment, social distancing, employee morale, hospice inpatient unit, emotional distress
- MeSH terms
- COVID-19, Humans, Morals, Palliative Care, Qualitative Research, Pandemics
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