{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T14:01:07Z","timestamp":1777384867170,"version":"3.51.4"},"reference-count":35,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"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"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Healthcare professionals caring for children with life-threatening illnesses face frequent bioethical conflicts, often leading to moral distress. In pediatric palliative care (PPC), this can compromise both professional well-being and quality of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To analyze moral distress among professionals in PPC and identify associated factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Cross-sectional study using the Measure of Moral Distress for Healthcare Professionals \u2013 Brazilian Version (MMD-HP BR) scale, applied online to PPC professionals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 112 professionals participated, mean age 41\u00a0years (\u00b19.1), predominantly female (90.2%) and from the Southeast region (49%). Average professional experience was 15\u00a0years (\u00b19.2), with 6\u00a0years (\u00b14.3) in PPC. Most participants were physicians (55.4%) and nurses (13.4%). The mean MMD-HP BR score was 104.2 (\u00b174.8), significantly correlated with profession (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.045). Nursing technicians had lower distress compared to nurses (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.014), physiotherapists (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.02), physicians (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.002) and psychologists (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.014). Higher scores were found among professionals who had considered leaving, had left, or were considering leaving their jobs. The most impactful items were: \u201cI observe health professionals communicating \u2018false hopes\u2019 to the patient or family\u201d and \u201cI observe poor quality care due to lack of communication between team members\u201d.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Moral distress in PPC is strongly linked to communication difficulties, a critical factor in professionals\u2019 experiences. The scarcity of studies in pediatrics, especially in Brazil, highlights the need for further research to develop strategies that support team well-being and improve the quality of care provided to children and families.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10499091251384586","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T11:22:52Z","timestamp":1759490572000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Moral Distress in Pediatric Palliative Care: A Cross-Sectional Study with Brazilian Professionals"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6417-2125","authenticated-orcid":false,"given":"Julianna Rodrigues","family":"Beltr\u00e3o","sequence":"first","affiliation":[{"name":"Pontif\u00edcia Universidade Cat\u00f3lica do Paran\u00e1, Curitiba, Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly Sales","family":"Zem","sequence":"additional","affiliation":[{"name":"Pontif\u00edcia Universidade Cat\u00f3lica do Paran\u00e1, Curitiba, Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0225-1343","authenticated-orcid":false,"given":"Luana da Rocha","family":"Celli","sequence":"additional","affiliation":[{"name":"Pontif\u00edcia Universidade Cat\u00f3lica do Paran\u00e1, Curitiba, Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9340-8704","authenticated-orcid":false,"given":"Carla","family":"Corradi-Perini","sequence":"additional","affiliation":[{"name":"Pontif\u00edcia Universidade Cat\u00f3lica do Paran\u00e1, Curitiba, Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1080\/23294515.2019.1586008"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2016.1239782"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/0969733007086023"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pedn.2015.03.001"},{"key":"e_1_3_3_6_2","volume-title":"Atlas Dos Cuidados Paliativos No Brasil 2019","author":"dos Santos AFJ","year":"2020","unstructured":"dos Santos AFJ, Ferreira EAL, Guirro \u00daB do PG. 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