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

Autor: Prokopová T; Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University and University Hospital Brno, Jihlavská 20, 625 00, Brno, Czech Republic.; Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 3, 625 00, Brno, Czech Republic., Hudec J; Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University and University Hospital Brno, Jihlavská 20, 625 00, Brno, Czech Republic.; Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 3, 625 00, Brno, Czech Republic., Vrbica K; Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University and University Hospital Brno, Jihlavská 20, 625 00, Brno, Czech Republic., Stašek J; Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University and University Hospital Brno, Jihlavská 20, 625 00, Brno, Czech Republic., Pokorná A; Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Masaryk University, Kamenice 3, 625 00, Brno, Czech Republic.; Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Kamenice 3, 625 00, Brno, Czech Republic.; Department of Health Sciences, Faculty of Medicine, Masaryk University, Kamenice 3, 625 00, Brno, Czech Republic., Štourač P; Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 3, 625 00, Brno, Czech Republic.; Department of Paediatric Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University and University Hospital Brno, Černopolní 9, 613 00, Brno, Czech Republic., Rusinová K; Department of Palliative Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Karlovo náměstí 32, 128 08, Prague, Czech Republic., Kerpnerová P; ANOVA CRO S.R.O., Prague, Czech Republic., Štěpánová R; Department of Pharmacology, Medical Faculty of Masaryk University, Kamenice 3, 625 00, Brno, Czech Republic., Svobodník A; Department of Pharmacology, Medical Faculty of Masaryk University, Kamenice 3, 625 00, Brno, Czech Republic., Maláska J; Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University and University Hospital Brno, Jihlavská 20, 625 00, Brno, Czech Republic. malaska.jan@fnbrno.cz.; Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 3, 625 00, Brno, Czech Republic. malaska.jan@fnbrno.cz.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2022 Jul 19; Vol. 26 (1), pp. 221. Date of Electronic Publication: 2022 Jul 19.
DOI: 10.1186/s13054-022-04066-1
Abstrakt: Background: Providing palliative care at the end of life (EOL) in intensive care units (ICUs) seems to be modified during the COVID-19 pandemic with potential burden of moral distress to health care providers (HCPs). We seek to assess the practice of EOL care during the COVID-19 pandemic in ICUs in the Czech Republic focusing on the level of moral distress and its possible modifiable factors.
Methods: Between 16 June 2021 and 16 September 2021, a national, cross-sectional study in intensive care units (ICUs) in Czech Republic was performed. All physicians and nurses working in ICUs 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 analyse possible modifiable factors of moral distress.
Results: In total, 313 HCPs (14.5% out of all HCPs who opened the questionnaire) fully completed the survey. Results showed that 51.8% (n = 162) of respondents were exposed to moral distress during the COVID-19 pandemic. 63.1% (n = 113) of nurses and 71.6% of (n = 96) physicians had experience with the perception of inappropriate care. If inappropriate care was perceived, a 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, the chance for moral distress 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.
Conclusions: HCPs working at ICUs experienced significant moral distress during the COVID-19 pandemic in the Czech Republic. The major sources were perceiving inappropriate care and dying of patients without dignity. Improvement of the decision-making process and communication at the end of life could lead to a better ethical and safety climate.
Trial Registration: NCT04910243 .
(© 2022. The Author(s).)
Databáze: MEDLINE
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