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. 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. 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. 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 .

中文翻译：

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COVID-19 大流行期间的姑息治疗实践和道德困扰（PEOpLE-C19 研究）：捷克共和国重症监护病房的全国性横断面研究

在 COVID-19 大流行期间，在重症监护病房 (ICU) 中提供临终关怀 (EOL) 似乎有所改变，这可能会给医疗保健提供者 (HCP) 带来道德困扰。我们寻求评估捷克共和国 ICU 中 COVID-19 大流行期间 EOL 护理的实践，重点关注道德困扰的程度及其可能的可改变因素。2021 年 6 月 16 日至 2021 年 9 月 16 日期间，在捷克共和国的重症监护病房 (ICU) 进行了一项全国性横断面研究。在 COVID-19 大流行期间在 ICU 工作的所有医生和护士都被纳入研究。问卷开发使用了 ACADEMY 和 CHERRIES 指南和清单。多变量逻辑回归模型用于分析道德困扰的可能改变因素。总共有 313 名 HCP（14. 打开问卷的所有 HCP 中有 5%）完全完成了调查。结果显示，51.8%（n = 162）的受访者在 COVID-19 大流行期间遭受了道德困扰。63.1% (n = 113) 的护士和 71.6% (n = 96) 的医生有过不当护理感知的经验。如果发现护理不当，则发现 HCP 发生道德困扰的可能性更高（OR，1.854；CI，1.057-3.252；p = 0.0312）。当患者有尊严地死去时，精神痛苦的机会较低（OR，0.235；CI，0.128-0.430；p < 0.001）。大流行期间姑息治疗实践中最常报告的三个差异是卫生系统拥堵、人员因素和 COVID-19 感染的特征。在捷克共和国的 COVID-19 大流行期间，在 ICU 工作的 HCP 经历了重大的道德困扰。主要来源是不适当的护理和没有尊严的病人死亡。改进临终时的决策过程和沟通可能会带来更好的道德和安全氛围。试用注册：NCT04910243。