Graduated Program in Bioethics, School of Life Sciences, 28100Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, Curitiba, Brazil.
Am J Hosp Palliat Care. 2021 Nov;38(11):1391-1397. doi: 10.1177/1049909120978826. Epub 2020 Dec 7.
The practice of palliative care is involved with ethical conflicts related to the life-death process and relief of suffering. The inability to act in the face of such dilemmas, due to internal or external barriers, can cause moral distress in the healthcare professionals.
The purpose of this integrative review is to analyze which circumstances cause moral distress in healthcare professionals who work in palliative care.
An integrative review of the literature was made in the SCIELO and PubMed databases, based on the descriptors "palliative care" and "moral distress." Articles published between 2015-2020, in Portuguese, Spanish and English were included, following the PRISMA criteria.
From a selection of 97 documents, 56 were completed reviewed and 23 studies were included in the review. Most articles refer to the nursing area, followed by multidisciplinary studies. The circumstances related to moral distress were identified involving: personal aspects; patients and caregivers; team; environment and organization. Communication problems, lack of resources and witnessing professionals giving false hope to patient and family members were the events related to moral distress most mentioned by the articles in the review. Recommendations for reducing and preventing moral distress include empowerment and educational programs in bioethics and palliative care.
Moral distress is an evident phenomenon in palliative care, involving different situations that can impact on quality-of-care provided as well as the well-being of the healthcare professionals.
姑息治疗的实践涉及与生死过程和缓解痛苦相关的伦理冲突。由于内部或外部障碍，面对这些困境无法采取行动，可能会导致医疗保健专业人员产生道德困境。
本次综合回顾的目的是分析在姑息治疗中工作的医疗保健专业人员在哪些情况下会产生道德困境。
在 SCIELO 和 PubMed 数据库中进行了综合文献回顾，使用了“姑息治疗”和“道德困境”这两个主题词。纳入了 2015 年至 2020 年间发表的、使用葡萄牙语、西班牙语和英语撰写的文章，符合 PRISMA 标准。
从 97 篇文献中筛选出 56 篇进行了完整的回顾，共有 23 项研究被纳入综述。大多数文章涉及护理领域，其次是多学科研究。与道德困境相关的情况包括：个人方面；患者和护理人员；团队；环境和组织。沟通问题、资源缺乏以及目睹专业人员向患者和家属提供虚假希望等与道德困境相关的事件在综述中被提及最多。减少和预防道德困境的建议包括在生物伦理学和姑息治疗方面提供赋权和教育计划。
道德困境是姑息治疗中一个明显的现象，涉及到不同的情况，可能会影响到提供的护理质量以及医疗保健专业人员的福祉。
