Moral injury and the myth of resilience: A qualitative exploration of cancer care provision in ontario throughout the COVID-19 pandemic

The COVID-19 pandemic profoundly altered the provision, experience, and outcomes of cancer care around the globe. With untold pressures on healthcare systems as well as unprecedented disruptions to cancer care services, those working in cancer care were exposed to new and intensified morally challenging and potentially traumatic conditions. This study qualitatively explores those experiences in two hospitals located in different regions of Ontario, Canada. Through interviews and focus groups with 32 individuals we found that healthcare workers navigated and were impacted by a variety of ongoing potentially morally injurious events and circumstances. We identified a number of themes and subthemes detailing their experiences of moral distress and injury arising from: 1) participating in perceived patient harms through changes in care provision such as delays and cancellations, 2) bearing witness to patients navigating care alone, 3) experiencing collective trauma with patients, families, and colleagues, and 4) feeling betrayed by leadership and the organization for, at times, leaving them feeling unsupported, unheard, undervalued, and undermined. This study provides a novel contribution by delineating both the heterogeneous and collective nature of pandemic-related events and circumstances that may be contributing to the ongoing moral distress and injury of healthcare workers. It also serves to provoke a discussion of moral injury and the myth of resilience in light of both the organizational contributions (e.g. resilience narratives) to the experience of moral injury and the promise of systems approaches for prevention and mitigation. Organizational sanctuary is explored as a systems model for providing safe and supportive working environments.