道德困境（MoD）在肿瘤学领域的医疗保健专业人员（HCPs）中十分普遍，并与工作倦怠有关。本研究的目的是在加拿大四级医疗保健医院中量化儿科肿瘤学医疗保健专业人员（HCPs）的道德困境，找出其根本原因，并评估随时间的变化。识别符合条件的儿科肿瘤学HCPs参与者，然后获得参与者的同意，在基线时完成医疗保健专业人员道德困境测量量表（MMD-HP）和道德困境温度计（MDT），随后在接下来的12周内每两周完成MDT。共有139名HCPs参与了研究。MMD-HP的平均分数为123 ± 57.0，范围为9-288。女性性别（女性127.1和男性83.6，P = .01）和护理角色（护士136.3和主要责任医生85.3，P = .02）被确定为与较高MMD-HP分数相关的人口学风险因素。与不考虑辞职的HCPs相比，当前考虑因为道德困境而辞职的HCPs的MMD-HP得分更高（169.9对115.4，P <.001）。涉及给予被认为过度激进的预后较差的患儿治疗的情况被排名为对道德困境做出最大环境贡献的原因。基线和随时间变化的MDT平均分数与MMD-HP分数强烈相关（P <.0001和P =.0003），而MDT平均分数在12周期间没有显着波动。儿科肿瘤学HCPs中普遍存在道德困境。导致较高道德困境水平的风险因素包括人口学和环境因素。实施改善团队沟通和决策制定的系统，特别是在治疗预后较差的患者时，可能会影响HCP的道德困境。

Moral distress (MoD) is prevalent among health care professionals (HCPs) in oncology and is associated with burnout. The objectives of this study were to quantify MoD among pediatric oncology healthcare professionals (HCPs) at a Canadian quaternary care hospital, identify root causes, and evaluate change over time.Eligible pediatric oncology HCPs were identified, and consenting participants completed the Measure of Moral Distress-Healthcare Professionals (MMD-HP) and MoD Thermometer (MDT) at baseline, followed by biweekly MDTs over 12 weeks.A total of 139 HCPs participated. The mean MMD-HP score was 123 ± 57.0, range 9-288. Demographic risk factors identified for elevated MMD-HP scores were female sex (female 127.1 and male 83.6, P = .01) and nursing role (nurse 136.3 and most responsible physician 85.3, P = .02). Higher MMD-HP scores were found in HCPs who were currently considering resigning because of MoD compared with those who were not (169.9 v 115.4, P < .001). Situations involving administration of treatment to children with poor prognosis cancers that was perceived to be overly aggressive were ranked as the greatest environmental contributor to MoD. Baseline and mean MDT scores over time strongly correlated with MMD-HP scores (P < .0001 and P = .0003, respectively), with mean MDT scores showing no significant fluctuation over the 12-week period.MoD was common among pediatric oncology HCPs. Risk factors for elevated levels of MoD included both demographic and environmental factors. Implementation of systems to improve team communication and decision making, especially in the care of patients with poor prognosis cancers, may affect HCP MoD.