Palliative care practice and moral distress during COVID-19 pandemic (PEOpLE-C19 study): a national, cross-sectional study in the Czech Republic

Abstract BackgroundProviding palliative care, including end-of-life decisions (EOLD), seems to be modified during the COVID-19 pandemic with potential burden of moral distress (MD) to health care providers (HCPs) We seek to assess the practice of palliative care during the COVID-19 pandemic in the Czech Republic focusing on the level of moral distress and its possible modifiable factors.MethodsBetween June 16, 2021, and September 16, 2021, a national, cross-sectional study in intensive care units (ICU) in Czech Republic was performed. Physicians and nurses working in ICU during the COVID-19 pandemic were included in the study. For questionnaire development ACADEMY and CHERRIES guide and checklist were used. A multivariate logistic regression model was used to analyses possible modifiable factors of MD.ResultsIn total, 313 HCPs (14.5% out of all opened questionnaires) fully completed the survey. Results showed that 51.8% (n = 162) of respondents were exposed to MD during the COVID-19 pandemic. 63.1% (n = 113) of nurses and 71.6% of (n = 96) physicians had experience with the perception of disproportionate care. If disproportionate care was perceived, higher chance for the occurrence of moral distress for HCPs (OR, 1.854; CI, 1.057–3.252; p = 0.0312) was found. When patients died with dignity, chance for MD was lower (OR, 0.235; CI, 0.128–0.430; p < 0.001). The three most often reported differences in palliative care practice during pandemic were health system congestion, personnel factors, and characteristics of COVID-19 infection.ConclusionsHCPs working at ICUs experienced significant MD during the COVID-19 pandemic in the Czech Republic. The major sources were perceiving disproportionate care and dying of patients without dignity. Strategies for improvement in communication and ethical climate must be prioritised.Trial registration NCT04910243; https://clinicaltrials.gov/ct2/show/NCT04910243. Registered 2 June 2021