Under the shadow of Ethical dilemmas: a Qualitative study of pediatric Oncology nurses’ End-of-Life Care experiences

Abstract

Despite advances in pediatric oncology, end-of-life (EOL) care remains ethically and emotionally challenging for nurses, often resulting in moral distress and complex decision-making. While ethics in adult oncology and palliative care are well documented, qualitative evidence in pediatric oncology nursing remains limited. Objective: To explore pediatric oncology nurses’ experiences of ethical dilemmas in EOL care. Interventions Methods: A qualitative descriptive design was employed using online semistructured focus group interviews. Pediatric oncology nurses providing EOL care were recruited through purposive sampling. Three focus groups (4–5 participants each) were conducted via Zoom between November and December 2025. Data were analyzed inductively using Braun and Clarke’s thematic analysis, supported by MAXQDA, with rigor enhanced through Consolidated Criteria for Reporting Qualitative Research-guided reporting and investigator triangulation. Results: Thirteen female nurses participated (mean age 39.31 ± 7.18 years), most with ≥5 years of experience and employed in university hospitals. Three main themes emerged: (1) Ethical Issues in End-of-Life Clinical Care; (2) Lack of Authority in Decision-Making Mechanisms and Ethical Silence; and (3) The Emotional and Professional Cost of Ethical Conflicts. Nurses described persistent moral distress shaped by resource limitations, physician-centered decision-making, and uncertainty regarding ethical standards. Conclusion: Pediatric oncology nurses experience multilayered ethical dilemmas in EOL care, intensified by limited decision-making authority and insufficient institutional guidance. Implications for Oncology Nursing Practice: Strengthening pediatric EOL standards, ethics consultation, interprofessional collaboration, and targeted support may reduce moral distress and promote ethically sustainable, high-quality care for children and families.