title: The nature of ethical conflicts and the meaning of moral community in oncology practice.
abstract: OBJECTIVE
  To explore ethical conflicts in oncology practice and the nature of healthcare contexts in which ethical conflicts can be averted or mitigated.
  
  
  METHODS
  Ethnography.
  
  
  METHODS
  Medical centers and community hospitals with inpatient and outpatient oncology units in southern California and Minnesota.
  
  
  METHODS
  30 oncology nurses, 6 ethicists, 4 nurse administrators, and 2 oncologists.
  
  
  METHODS
  30 nurses participated in six focus groups that were conducted using a semistructured interview guide. Twelve key informants were individually interviewed. Coding, sorting, and constant comparison were used to reveal themes.
  
  
  RESULTS
  Most ethical conflicts pertained to complex end-of-life situations. Three factors were associated with ethical conflicts: delaying or avoiding difficult conversations, feeling torn between competing obligations, and the silencing of different moral perspectives. Moral communities were characterized by respectful team relationships, timely communication, ethics-minded leadership, readily available ethics resources, and provider awareness and willingness to use ethics resources.
  
  
  CONCLUSIONS
  Moral disagreements are expected to occur in complex clinical practice. However, when they progress to ethical conflicts, care becomes more complicated and often places seriously ill patients at the epicenter.
  
  
  CONCLUSIONS
  Practice environments as moral communities could foster comfortable dialogue about moral differences and prevent or mitigate ethical conflicts and the moral distress that frequently follows.
authors.affiliation: School of Nursing, University of California, Los Angeles.
authors.forename: Carol
authors.initials: C
authors.lastname: Pavlish
authors.affiliation: Healthcare Ethics Center, University of California, Los Angeles.
authors.forename: Katherine
authors.initials: K
authors.lastname: Brown-Saltzman
authors.affiliation: University of California, Los Angeles, in Santa Monica.
authors.forename: Patricia
authors.initials: P
authors.lastname: Jakel
authors.affiliation: University of California, Los Angeles.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Fine
mesh_terms: D000328:Adult; D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D003220:Conflict, Psychological; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008495:Medical Oncology / Q000941:ethics*; D009014:Morals; D009369:Neoplasms / Q000451:nursing / Q000628:therapy; D009718:Nurse Administrators / Q000941:ethics; D009859:Oncology Nursing / Q000941:ethics*
keywords: ethics; qualitative nursing research; workplace issues