Moral Distress in Pediatric Palliative Care: A Cross-Sectional Study with Brazilian Professionals

IntroductionHealthcare 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.ObjectiveTo analyze moral distress among professionals in PPC and identify associated factors.MethodCross-sectional study using the Measure of Moral Distress for Healthcare Professionals - Brazilian Version (MMD-HP BR) scale, applied online to PPC professionals.ResultsA total of 112 professionals participated, mean age 41 years (±9.1), predominantly female (90.2%) and from the Southeast region (49%). Average professional experience was 15 years (±9.2), with 6 years (±4.3) in PPC. Most participants were physicians (55.4%) and nurses (13.4%). The mean MMD-HP BR score was 104.2 (±74.8), significantly correlated with profession (<i>P</i> = 0.045). Nursing technicians had lower distress compared to nurses (<i>P</i> = 0.014), physiotherapists (<i>P</i> = 0.02), physicians (<i>P</i> = 0.002) and psychologists (<i>P</i> = 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: "I observe health professionals communicating 'false hopes' to the patient or family" and "I observe poor quality care due to lack of communication between team members".ConclusionMoral distress in PPC is strongly linked to communication difficulties, a critical factor in professionals' 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.