{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T03:46:54Z","timestamp":1792900014936,"version":"4.5.0"},"reference-count":39,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2020,12,7]],"date-time":"2020-12-07T00:00:00Z","timestamp":1607299200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The purpose of this integrative review is to analyze which circumstances cause moral distress in healthcare professionals who work in palliative care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>An integrative review of the literature was made in the SCIELO and PubMed databases, based on the descriptors \u201cpalliative care\u201d and \u201cmoral distress.\u201d Articles published between 2015-2020, in Portuguese, Spanish and English were included, following the PRISMA criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1049909120978826","type":"journal-article","created":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T12:27:57Z","timestamp":1607603277000},"page":"1391-1397","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":41,"title":["Circumstances Related to Moral Distress in Palliative Care: An Integrative Review"],"prefix":"10.1177","volume":"38","author":[{"given":"Carla","family":"Corradi-Perini","sequence":"first","affiliation":[{"name":"Graduated Program in Bioethics, School of Life Sciences, Pontif\u00edcia Universidade Cat\u00f3lica do Paran\u00e1, Rua Imaculada Concei\u00e7\u00e3o, Curitiba, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6417-2125","authenticated-orcid":false,"given":"Julianna Rodrigues","family":"Beltr\u00e3o","sequence":"additional","affiliation":[{"name":"Graduated Program in Bioethics, School of Life Sciences, Pontif\u00edcia Universidade Cat\u00f3lica do Paran\u00e1, Rua Imaculada Concei\u00e7\u00e3o, Curitiba, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uiara Raiana Vargas de Castro Oliveira","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Graduated Program in Bioethics, School of Life Sciences, Pontif\u00edcia Universidade Cat\u00f3lica do Paran\u00e1, 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