Author:
Prokopová Tereza,Hudec Jan,Vrbica Kamil,Stašek Jan,Pokorná Andrea,Štourač Petr,Rusinová Kateřina,Kerpnerová Paulína,Štěpánová Radka,Svobodník Adam,Maláska Jan,Maláska Jan,Rusinová Kateřina,Černý David,Klučka Jozef,Pokorná Andrea,Světlák Miroslav,Duška František,Kratochvíl Milan,Slezáčková Alena,Kratochvíl Milan,Štourač Petr,Gabrhelík Tomáš,Kuře Josef,Suk Daniel,Doležal Tomáš,Prokopová Tereza,Čerňanová Jana,Vrbica Kamil,Fabiánková Klára,Straževská Eva,Hudec Jan,
Abstract
Abstract
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.
Graphical abstract
Funder
Technologická Agentura České Republiky
Ministerstvo Zdravotnictví Ceské Republiky
Ministerstvo Školství, Mládeže a Tělovýchovy
European Regional Development Fund
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
Reference44 articles.
1. Radbruch L, de Lima L, Knaul F, Wenk R, Ali Z, Bhatnaghar S, et al. Redefining palliative care—a new consensus-based definition. J Pain Symp Manag. 2020;60:754–64.
2. Radbruch L, SA P. White paper on standards and norms for hospice and palliative care in Europe: part 1. Eur J Palliat Care. 2010;17:22–33.
3. Mercadante S, Gregoretti C, Cortegiani A. Palliative care in intensive care units: why, where, what, who, when, how. BMC Anesthesiol. 2018. https://doi.org/10.1186/s12871-018-0574-9.
4. Zangrillo A, Beretta L, Scandroglio AM, Monti G, Fominskiy E, Colombo S, et al. Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan. Italy Crit Care Resusc NLM. 2020;22:200–11.
5. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA J Am Med Assoc Am Med Assoc. 2020;323:1574–81.