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Care planning based on advance directives is vital to preserve the autonomy and dignity of patients. In view of this, this study sought to verify the level of knowledge of medical residents of Curitiba, Paraná, Brazil, about them and their use in clinical practice. The feeling of these professionals regarding their knowledge and safety about the instrument was also evaluated. A quantitative and cross-sectional research was carried out by applying a structured questionnaire on a digital platform with a final sample of 45 participants. The results indicate that the knowledge of these professionals about the concept and legal aspects of advance directives is insufficient.

Resumen La planificación de cuidados con base en las directivas anticipadas de voluntad es vital para la preservación de la autonomía y dignidad de los pacientes. Ante esto, se pretende evaluar el nivel de conocimiento de los médicos residentes de Curitiba, Paraná, Brasil, sobre el tema y su uso en la práctica clínica. También se estimó el sentimiento que tienen estos profesionales sobre el conocimiento y confianza en este instrumento. Se realizó una investigación cuantitativa y transversal a partir de un cuestionario estructurado aplicado a una muestra final de 45 participantes en una plataforma digital. Los resultados indican que son insuficientes los conocimientos de estos profesionales sobre el concepto y los aspectos legales de las directivas anticipadas.

Background: The practice of palliative care is involved with ethical conflicts related to the life-death process and relief of suffering. The inability to act in the face of such dilemmas, due to internal or external barriers, can cause moral distress in the healthcare professionals. Objective: The purpose of this integrative review is to analyze which circumstances cause moral distress in healthcare professionals who work in palliative care. Methods: An integrative review of the literature was made in the SCIELO and PubMed databases, based on the descriptors “palliative care” and “moral distress.” Articles published between 2015-2020, in Portuguese, Spanish and English were included, following the PRISMA criteria. Results: From a selection of 97 documents, 56 were completed reviewed and 23 studies were included in the review. Most articles refer to the nursing area, followed by multidisciplinary studies. The circumstances related to moral distress were identified involving: personal aspects; patients and caregivers; team; environment and organization. Communication problems, lack of resources and witnessing professionals giving false hope to patient and family members were the events related to moral distress most mentioned by the articles in the review. Recommendations for reducing and preventing moral distress include empowerment and educational programs in bioethics and palliative care. Conclusions: Moral distress is an evident phenomenon in palliative care, involving different situations that can impact on quality-of-care provided as well as the well-being of the healthcare professionals.

Moral-uncertainty-distress (MUD) é o distresse moral relacionado ao conflito sobre qual melhor decisão em situações moralmente complexas. Propomos identificar a relação entre percepção do médico sobre as Diretivas Antecipadas de Vontade (DAV) e MUD, assim como o impacto na tomada de decisão. Neste estudo qualitativo, realizou-se entrevistas semiestruturadas com oito médicos de um hospital em Curitiba-PR tendo por base uma DAV verídica e, posteriormente, submetidas ao método de análise de conteúdo por categorização de Bardin. A primeira categoria identificada, DAV como elementos de conflito moral, revelou atitudes paternalistas por parte dos entrevistados, assim como insegurança por incertezas prognósticas, questionamento das DAV considerando motivações prévias do paciente e pouco conhecimento sobre as DAV. O reconhecimento das DAV como instrumentos de exercício da autonomia do paciente constituiu a segunda categoria encontrada. Apesar da identificação das DAV como ferramentas de autonomia, outros aspectos se mostraram moralmente desafiadores para os médicos entrevistados, sendo potencial fonte de MUD e impactando a tomada de decisão.

Background: moral-uncertainty-distress (MUD) is defined as moral distress related to moral conflict about best course of action, impacting the clinical decision making process in morally complex situations. This study aims to correlate physician’s perception about advance directives (AD) with presence or absence of MUD, identifying the impact that AD promotes on clinical decision making.Methods: this is a qualitative, cross-sectional, exploratory study. Data was collected through semi-structured interviews with physicians of a hospital in southern Brazil. Interviews content was submitted to categorization analysis content technique by Laurence Bardin.Results: eight physicians were interviewed. The analysis contend identified two categories: (1) AD as a morally challenging element and (2) recognition of AD as instruments that exercises patient’s autonomy. In the first, paternalistic attitude; insecurities in uncertain prognoses; uncertainty about patient values and motivations to write the document; and little previous knowledge about AD, were elements of MUD for physicians. In second category, autonomy in AD was seen as prima facie principle and as shared autonomy.Conclusion: although AD were comprehended as instruments of exercise of patient’s autonomy by the participants, some elements were morally challenging for them, which can be a source of MUD to physician during decision making process.