BACKGROUND: Providing palliative care at the end of life (EOL) in intensive care units (ICUs) seems to be modified during the COVID-19 pandemic with potential burden of moral distress to health care providers (HCPs). We seek to assess the practice of EOL care during the COVID-19 pandemic in ICUs in the Czech Republic focusing on the level of moral distress and its possible modifiable factors. METHODS: Between 16 June 2021 and 16 September 2021, a national, cross-sectional study in intensive care units (ICUs) in Czech Republic was performed. All physicians and nurses working in ICUs during the COVID-19 pandemic were included in the study. For questionnaire development ACADEMY and CHERRIES guide and checklist were used. A multivariate logistic regression model was used to analyse possible modifiable factors of moral distress. RESULTS: In total, 313 HCPs (14.5% out of all HCPs who opened the questionnaire) fully completed the survey. Results showed that 51.8% (n = 162) of respondents were exposed to moral distress during the COVID-19 pandemic. 63.1% (n = 113) of nurses and 71.6% of (n = 96) physicians had experience with the perception of inappropriate care. If inappropriate care was perceived, a higher chance for the occurrence of moral distress for HCPs (OR, 1.854; CI, 1.057-3.252; p = 0.0312) was found. When patients died with dignity, the chance for moral distress was lower (OR, 0.235; CI, 0.128-0.430; p < 0.001). The three most often reported differences in palliative care practice during pandemic were health system congestion, personnel factors, and characteristics of COVID-19 infection. CONCLUSIONS: HCPs working at ICUs experienced significant moral distress during the COVID-19 pandemic in the Czech Republic. The major sources were perceiving inappropriate care and dying of patients without dignity. Improvement of the decision-making process and communication at the end of life could lead to a better ethical and safety climate. TRIAL REGISTRATION: NCT04910243 .

ANOVA CRO S R O Prague Czech Republic

Czech National Centre for Evidence Based Healthcare and Knowledge Translation Faculty of Medicine Masaryk University Kamenice 3 625 00 Brno Czech Republic

Department of Anaesthesiology and Intensive Care Medicine Faculty of Medicine Masaryk University and University Hospital Brno Jihlavská 20 625 00 Brno Czech Republic

Department of Health Sciences Faculty of Medicine Masaryk University Kamenice 3 625 00 Brno Czech Republic

Department of Paediatric Anaesthesiology and Intensive Care Medicine Faculty of Medicine Masaryk University and University Hospital Brno Černopolní 9 613 00 Brno Czech Republic

Department of Palliative Medicine 1st Faculty of Medicine Charles University and General University Hospital Prague Karlovo náměstí 32 128 08 Prague Czech Republic

Department of Pharmacology Medical Faculty of Masaryk University Kamenice 3 625 00 Brno Czech Republic

Department of Simulation Medicine Faculty of Medicine Masaryk University Kamenice 3 625 00 Brno Czech Republic

Faculty of Medicine Institute of Biostatistics and Analyses Masaryk University Kamenice 3 625 00 Brno Czech Republic

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NCT04910243