Background Working as a neonatologist in a neonatal intensive care unit (NICU) is stressful and involves ethically challenging situations. These situations may cause neonatologists to experience high levels of moral distress, especially in the context of caring for extremely premature infants (EPIs). In Greece, moral distress among neonatologists working in NICUs remains understudied and warrants further exploration. Methods This prospective qualitative study was conducted from March to August 2022. A combination of purposive and snowball sampling was used and data were collected by semi-structured interviews with twenty neonatologists. Data were classified and analyzed by thematic analysis approach. Results A variety of distinct themes and subthemes emerged from the analysis of the interview data. Neonatologists face moral uncertainty. Furthermore, they prioritize their traditional (Hippocratic) role as healers. Importantly, neonatologists seek third-party support for their decisions to reduce their decision uncertainty. In addition, based on the analysis of the interview data, multiple predisposing factors that foster and facilitate neonatologists’ moral distress emerged, as did multiple predisposing factors that are sometimes associated with neonatologists’ constraint distress and sometimes associated with their uncertainty distress. The predisposing factors that foster and facilitate neonatologists’ moral distress thus identified include the lack of previous experience on the part of neonatologists, the lack of clear and adequate clinical practice guidelines/recommendations/protocols, the scarcity of health care resources, the fact that in the context of neonatology, the infant’s best interest and quality of life are difficult to identify, and the need to make decisions in a short time frame. NICU directors, neonatologists’ colleagues working in the same NICU and parental wishes and attitudes were identified as predisposing factors that are sometimes associated with neonatologists’ constraint distress and sometimes associated with their uncertainty distress. Ultimately, neonatologists become more resistant to moral distress over time. Conclusions We concluded that neonatologists’ moral distress should be conceptualized in the broad sense of the term and is closely associated with multiple predisposing factors. Such distress is greatly affected by interpersonal relationships. A variety of distinct themes and subthemes were identified, which, for the most part, were consistent with the findings of previous research. However, we identified some nuances that are of practical importance. The results of this study may serve as a starting point for future research.

Based on the study results, ACLAW, a technique much easier and shorter than the traditional abdominal colpopexy results in comparable outcomes.

Background As advances in oncology have led to remarkable and steady improvements in the survival rates of cancer patients and anticancer treatment can cause premature ovarian failure in women, fertility preservation has become a global public health concern and an integral part of the care for women diagnosed with cancer during reproductive age. However, for various reasons, fertility preservation remains underutilized for cancer patients. There are substantial gaps in our knowledge about women’s experience and perceptions on the issue. This study aims to contribute to bridging that gap. Methods This prospective qualitative study was conducted from March 2018 to February 2023. A combination of purposive and snowball sampling was used. Data were collected by semi-structured interviews with nineteen reproductive-age women with a recent cancer diagnosis. Data were classified and analyzed by a thematic analysis approach. Results A variety of distinct themes and subthemes emerged from the analysis of the interview data. The cancer diagnosis emerged as a factor that considerably affects the women’s attitudes towards biological parenthood: It can further increase their (strong) previous desire or decrease their previous (weak) desire. Women with a recent cancer diagnosis did not receive adequate and multidisciplinary counselling, including clear and sufficient information. However, participants felt satisfied from the information they received because they either received the information they requested or remained in denial to get informed (i.e. because they felt overwhelmed after the cancer diagnosis). Embryo cryopreservation emerged as a less desirable fertility preservation option for women with cancer. Participants showed respect for human embryos, not always for religious reasons. Surrogacy emerged as the last resort for most participants. Religious, social or financial factors did play a secondary (if any) role in women’s decision making about fertility preservation. Finally, male partners’ opinions played a secondary role in most participants’ decision-making about fertility preservation. If embryo cryopreservation was the selected option, partners would have a say because they were involved with their genetic material. Conclusions The findings that emerged from data analysis were partly consistent with prior literature. However, we identified some interesting nuances that are of clinical importance. The results of this study may serve as a starting point for future research.

Background Working as neonatologist in the neonatal intensive care unit (NICU) is stressful and involves ethically challenging situations. Neonatologists’ periviable resuscitation or medical futility decisions involve an attempt to determine the infant’s best interest and strike a balance between infant’s best interest and respect for parents' autonomy. This may cause neonatologists to develop high levels of moral distress, especially when caring for extremely premature infants (EPIs) under high levels of prognostic uncertainty and without guidelines. In Greece, few qualitative studies are focusing primarily on neonatologists and provide little insight into how neonatologists working in the NICU make or perceive their decisions. Moral distress among neonatologists working in the NICU is a topic that is still understudied and warrants further exploration. Methods This was a prospective qualitative study that used semistructured interviews of twenty neonatologists who had been working in NICUs in Greece for at least one year. The study was conducted between March 2022 and August 2022. A thematic analysis of the data was performed. Results A variety of distinct themes and subthemes emerged from the interview data analysis. Neonatologists are confronted with moral conflicts perceived as irreconcilable. Furthermore, they prioritize their traditional (Hippocratic) role as healers. Importantly, neonatologists seek out a third-party support for their decisions to reduce their decision uncertainty. In addition, from the interview data analysis emerged multiple predisposing factors that further increase the neonatologists’ uncertainty distress or let it continue elevated, as well as multiple predisposing factors that may be associated with either neonatologists’ constraint distress or their uncertainty distress. Among the predisposing factors that further increase the neonatologists’ uncertainty distress or let it continue elevated have been identified, the lack of neonatologist’s previous experience, the lack of clear and adequate clinical practice guidelines / recommendations/ protocols, the shortage of healthcare resources, the fact that in the context of neonatology best interest and quality of life are determined with difficulty, the administration of an off-label medication and the need for making decisions in a short time frame. NICU directors, neonatologists’ colleagues working in the same NICU and parental wishes and attitudes have been identified as predisposing factors that may be associated with either neonatologists’ constraint or their uncertainty distress. Ultimately, neonatologists become more resistant to moral distress over time Conclusions We concluded that neonatologists’ moral distress should be conceptualized in the broad sense of the term and is strictly associated with multiple predisposing factors. It is greatly affected by interpersonal relationships. A variety of distinct themes and subthemes were identified, which, for the most part, were consistent with prior literature. However, we identified some nuances that are of practical importance. The results of this study support the need for establishing Institutional Ethics Committees in every healthcare setting and make neonatologist aware of them. Furthermore, the results of this study support the need to make professional psychological counselling available in every NICU. Ultimately, the results of this study may serve as a starting point for future research.