Difficult situations and moral questions raised during moral case deliberations in Swedish childhood cancer care – A qualitative nationwide study

Abstract

To describe performed moral case deliberations and present a nationwide study of difficult situations and moral questions raised by healthcare professionals during moral case deliberations in Swedish childhood cancer care. Written reports (n=72) about difficult situations and moral questions were completed by healthcare professionals, trained as facilitators, who implemented moral case deliberations at all paediatric oncology centres in Sweden. A qualitative systematic text condensation was used for data analysis. A pattern of biopsychosocial factors was found in the difficult situations, including medical, psycho-social, and religious/cultural information. Three different themes of moral questions emerged. The first, "What is the limit of healthcare professionals' responsibilities?", included whether, and to what degree, healthcare professionals should depart from professional values, and whether/when to interfere with parents' choices in care. The second theme, "Who has a mandate to decide on care?", covered conflicting perspectives on care related to decision making. The third theme, "What is the right care action to take?", concerned the best interest of the child and moral questions about whether the chosen care action would promote a better or worse outcome. This study contributes to increased understanding of difficult situations and moral questions raised during moral case deliberations in Swedish childhood cancer care. Biopsychosocial factors are important to take into account in order to achieve a holistic view of the situation. Although several moral questions concerned medical treatment and life and death, others were related to everyday clinical practice and the differing perspectives of children, parents, and healthcare professionals.