Delivering serious news in palliative care and its relationship with moral distress among physicians: a qualitative study

Abstract

Communicating serious news is a complex and emotionally demanding task in palliative care and may contribute to moral distress among physicians. This study aimed to explore the moral conflicts that contribute to moral distress among physicians during the communication of serious news in palliative care. An exploratory qualitative study was conducted with 18 Brazilian physicians (7 men and 11 women) working in palliative care settings, including hospitals, hospices, and home care services. Semi-structured interviews, comprising nine core questions and two conditional follow-up questions, were conducted via Zoom, transcribed verbatim, and analyzed using ATLAS.ti 9. Data were examined through inductive thematic content analysis based on Bardin’s framework. Six main themes were identified as sources of moral conflict: perceived lack of professional competence; divergence in decision-making; lack of truthfulness toward the patient; barriers in the communication process; insufficient preparation for palliative care; and moral conflicts involving religion and spirituality. Physicians reported emotional responses consistent with moral distress, including concern about family reactions, emotional burden, sadness, and excessive empathy. Although most participants reported using communication protocols, such as SPIKES, significant challenges remained. Moral distress among physicians arises from complex interactions between ethical dilemmas, insufficient professional preparation, and relational and systemic constraints. Enhancing training in communication skills, palliative care, and bioethics, along with strengthening institutional support, is essential to improve the management of serious conversations and mitigate moral distress.