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O-2 ‘Going against the grain of all we do’: hospice staff experiences of moral distress during COVID-19
  1. Andy Bradshaw1,
  2. Lesley Dunleavy2,
  3. Ian Garner2,
  4. Nancy Preston2,
  5. Sabrina Bajwah3,
  6. Rachel Cripps3,
  7. Lorna Fraser4,
  8. Matthew Maddocks3,
  9. Mevhibe Hocaoglu3,
  10. Fliss Murtagh1,
  11. Adejoke Oluyase3,
  12. Katherine Sleeman3,
  13. Irene Higginson3 and
  14. Catherine Walshe2
  1. 1Hull York Medical School, University of Hull, Hull, UK
  2. 2International Observatory on End of Life Care, Lancaster University, Lancaster, UK
  3. 3Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
  4. 4Martin House Research Centre, Department of Health Sciences, University of York, York, UK


Background COVID-19 has placed huge stress on healthcare systems and services, often impacting the well-being of staff across all settings (Mehta, Machado, Kwizera, et al., 2021). Little is known about the pandemic’s impact on hospice staff.

Aims Identify how responding to COVID-19 has impacted hospice staff, whether and why this resulted in experiences of moral distress, and how hospices have responded in supporting staff well-being.

Methods Qualitative multiple case study (Yin, 2017) (n= five cases), as part of the CovPall study which explored the multinational response of specialist palliative services to the pandemic. Cases were hospices in England providing specialist palliative care services in any setting. Data collection involved individual interviews with hospice professionals and analysed using framework analysis (Ritchie, Lewis, Nicholls, et al., 2013).

Results 24 participants sampled by role, experience, and setting. Themes demonstrated how infection control constraints (i.e., visiting restrictions) prohibited and diluted staff’s capacity to provide care that reflected their professional values. This caused moral distress. Despite organisational, team, and individual support strategies to address moral distress, continually managing these constraints led to a ‘crescendo effect’ with cumulative effects of moral distress (e.g., sadness, guilt, frustration, and fatigue) sometimes leading to burnout. Solidarity with colleagues and the feeling of making a valued contribution provided ‘moral comfort’ for some.

Conclusions Despite their experience of dealing with death and dying, the well-being of hospice staff has been, and continues to be, affected by experiences of moral distress during the pandemic.

How innovative or of interest is the abstract We provide an in-depth insight into why and how hospice staff experienced moral distress during the pandemic, alongside how voluntary organisations responded. Given that prolonged experiences of moral distress has detrimental effects on staff and the quality of patient care, (Burston & Tuckett, 2013) national and organisational changes need to be implemented to alleviate and manage the short and long-term impact of moral distress (Jameton, 2017).

Funding statement The CovPall study is jointly funded by UKRI and NIHR [COV0011; MR/V012908/1]. Additional support was from the National Institute for Health Research (NIHR) Applied Research Collaboration, South London, hosted at King’s College Hospital NHS Foundation Trust, and Cicely Saunders International (Registered Charity No. 1087195).

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