Observing heroic behavior and its influencing factors in immersive virtual environments.

Studying heroism in controlled settings presents challenges and ethical controversies due to its association with physical risk. Leveraging virtual reality (VR) technology, we conducted a three-study series with 397 participants from China to investigate heroic actions. Participants unexpectedly witnessed a criminal event in a simulated scenario, allowing observation of their tendency to physically intercept a thief. We examined situational factors (voluntariness, authority, and risk) and personal variables [gender, impulsivity, empathy, and social value orientation (SVO)] that may influence heroism. Also, the potential association between heroism and social conformity was explored. In terms of situational variables, voluntariness modulated participants' tendency to intercept the escaping thief, while perceived risk demonstrated its impact by interacting with gender. That is, in study 3 where the perceived risk was expected to be higher (as supported by an online study 5), males exhibited a greater inclination toward heroic behavior compared to females. Regarding other personal variables, the tendency to engage in heroic behavior decreased as empathy levels rose among males, whereas the opposite trend was observed for females. SVO influenced heroic behavior but without a gender interaction. Finally, an inverse relationship between heroism and social conformity was observed. The robustness of these findings was partly supported by the Chinese sample (but not the international sample) of an online study 4 that provided written descriptions of VR scenarios, indicating cultural variations. These results advance insights into motivational factors influencing heroism in the context of restoring order and highlight the power of VR technology in examining social psychological hypotheses beyond ethical constraints.

Nurses' moral courage and related factors: A systematic review.

BACKGROUND: Nurses face various ethical conflicts when taking care of patients, and such conflicts require moral courage. This systematic review was conducted with the aim of investigating moral courage and its related factors among nurses. METHODS: To find related studies, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The PubMed, Web of Science, Google Scholar, Scopus, Embase and Science Direct databases were searched using keywords such as Courage, Moral Courage, and Nurses, and no lower time limit was imposed when conducting the searches. The identified studies were published between January 2000 and March 2023. Quality of articles was assessed using the STROBE checklist. RESULTS: The pooled sample size for the 19 included studies was 7863. All studies were observational and cross-sectional. The results showed that three categories of factors most related to moral courage are individual, moral, and factors related to the organization. Underlying factors of each category are also provided within this paper. CONCLUSION: Moral courage is an integral part of nursing, which as a profession, is becoming even more challenging with the advancement of science and technology. Therefore, there is a need for nurses and especially nursing managers to be considerate of factors affecting moral courage of nurses, with a view to strengthening the positive factors and reducing the negative impacts.

Brave spaces in nursing ethics education: Courage through pedagogy.

BACKGROUND: Nursing students must graduate prepared to bravely enact the art and science of nursing in environments infiltrated with ethical challenges. Given the necessity and moral obligation of nurses to engage in discourse within nursing ethics, nursing students must be provided a moral supportive learning space for these opportunities. Situating conversations and pedagogy within a brave space may offer a framework to engage in civil discourse while fostering moral courage for learners. RESEARCH OBJECTIVE: The aim of this research is to explore the influence of a structured self-assessment tool called the ESA "Engagement Self-Assessment" on the alignment and creation of a brave space in a nursing ethics course. RESEARCH DESIGN: This study used an exploratory, cross-sectional survey design. PARTICIPANTS AND STUDY SETTING: Data from 39 undergraduate nursing students enrolled in a nursing healthcare ethics & law course using the ESA were recruited. ETHICAL CONSIDERATIONS: Participation was voluntary and informed without coercion. Written consent was obtained prior to participation. Research ethics approval was obtained by the Institutional Research Ethics Board of the recruited participants (Ethics # 2022-23-03). FINDINGS: The ESA provided structured self-reflection on the impact of shared vulnerability within a brave space. However, commitment to a brave space was not strongly influenced by the ESA, but rather by a mutual "commitment to others." CONCLUSION: A teaching tool such as an ESA can be used to facilitate instructor expectations of civil discourse and discussion of difficult topics. Rules of engagement such as those found in brave spaces can help transform fear of vulnerability into authentic growth for learners. A morally supportive learning space can support critical opportunities for ethical development. This study provides insight into how self-assessment and the use of a brave space in nursing ethics education can facilitate a morally supportive learning space.

The relationship between moral courage and lovingkindness-compassion levels in critical care nurses: A cross-sectional study.

BACKGROUND: Ethical dilemmas and ethical problems are very common in intensive care units. Nurses need moral courage to deal with these problems. Nurses' high empathy, humility, lovingkindness, and compassion support them to act with moral courage. OBJECTIVES: The aim of this study was to determine the moral courage, lovingkindness, and compassion levels of critical care nurses and to reveal whether there is a relationship between them. METHODS: One hundred sixty-eight nurses working in the intensive care unit of a university hospital in Turkey were included in this correlational descriptive cross-sectional study. The data were collected with the Nurses' Moral Courage Scale (NMCS) and the Loving-kindness Compassion Scale (LCS). RESULTS: There was a positive and significant relationship between the NMCS and the LCS lovingkindness (r = .377, p < .05) and compassion (r = .405, p < .05) subdimensions; on the other hand, a negative and significant relationship was observed with the LCS self-centredness subdimension (r = -.215, p = .025). In addition, the mean scores of the LCS subdimensions of compassion, self-centredness, and lovingkindness were predictors of the NMCS total score (R = .475, R2 = .286, p < .05). CONCLUSIONS: In this study, it was determined that critical care nurses with high moral courage levels had high levels of compassion and lovingkindness and low levels of self-centredness. A high level of moral courage and compassion in nurses may contribute to quality and safe patient care. In-service trainings may be planned to increase nurses' awareness of moral courage, loving-kindness, and compassion.

'Prudence, Foresight, Courage, Oeconomy': glass beehives and English society, 1650-1680.

During the English Civil War and subsequent Restoration, beekeeping provided a ready set of moral examples for those seeking answers about the 'natural' structure of society. The practice itself also underwent a number of substantial changes, moving from a traditional craft practice to a more knowledge-focused, technologically complex one. The advent of glass-windowed hives in the latter half of the sixteenth century allowed intellectuals from across the political spectrum to directly observe bees as a way of gathering knowledge about how to understand the divine plan and, with that understanding, improve human society.

Moral distress, moral courage, and career identity among nurses: A cross-sectional study.

BACKGROUND: The concept of career identity is integral to nursing practices and forms the basis of the nursing professions. Positive career identity is essential for providing high-quality care, optimizing patient outcomes, and enhancing the retention of health professionals. Therefore, there is a need to explore potential influencing variables, thereby developing effective interventions to improve career identity. OBJECTIVES: To investigate the relationship between moral distress, moral courage, and career identity, and explore the mediating role of moral courage between moral distress and career identity among nurses. DESIGN: A quantitative, cross-sectional study. METHODS: A convenient sample of 800 nurses was recruited from two tertiary care hospitals between February and March 2022. Participants were assessed using the Moral Distress Scale-revised, Nurses' Moral Courage Scale, and Nursing Career Identity Scale. This study was described in accordance with the STROBE statement. ETHICAL CONSIDERATION: Research ethics approval was obtained from the researcher's university and hospital where this study was conducted prior to data collection. FINDINGS: Moral distress is negatively associated while moral courage is positively associated with career identity among nurses. Moral courage partially mediates the relationship between moral distress and career identity (ß = -0.230 to -0.163, p < 0.01). DISCUSSION: The findings reveal a relationship between moral distress, moral courage, and career identity among nurses. CONCLUSION: By paying attention to nurses' moral distress and courage, healthcare providers can contribute to the development of effective interventions to improve career identity, and subsequently performance, among nurses.

Moral courage of master's students of nursing during COVID-19.

BACKGROUND: Moral courage is a recognized virtue. In the context of the COVID-19 pandemic, the master's students of nursing (MSNs) in China have shown tenacious moral courage. OBJECTIVE: This study elaborates on the moral courage of Chinese MSNs through their experiences of volunteering during the pandemic. RESEARCH DESIGN: Descriptive qualitative, interview-based. PARTICIPANTS AND RESEARCH CONTEXT: Participants were nursing postgraduate students who participated in the prevention and control of the COVID-19 pandemic selected by purposeful sampling. The sample size was determined by data saturation, which was reached with 10 participants. Data were analyzed using a deductive method of content analysis. Because of the isolation policy, telephone interviews were adopted. ETHICAL CONSIDERATIONS: After obtaining the approval of the ethical institution of the author's school (No. 138, 30 August 2021), verbal consent was obtained before the interview with the participants. All data were processed anonymously and confidentially. In addition, we recruited participants through MSNs' counselors, and obtained their phone numbers with their permission. RESULTS: Data analysis resulted in 15 subcategories that were subsequently grouped into 3 major categories including proceed without hesitation, the outcome of practicing moral courage, and develop and maintain moral courage. CONCLUSION: This qualitative study is based on the special background of the COVID-19 pandemic, and the MSNs in China have shown tenacious moral courage in the work of epidemic prevention and control. Five factors led them to take action without hesitation, and six possible outcomes followed. Lastly, this study provides some suggestions for nurses and nursing students to enhance their moral courage. To better develop and support moral courage in the future, it is necessary to use different methods and multidisciplinary approaches to study moral courage.

Moral courage, job-esteem, and social responsibility in disaster relief nurses.

BACKGROUND: Social responsibility can motivate disaster relief nurses to devote themselves to safeguarding rights and interests of people when facing challenges that threaten public health. However, few studies focused on the relationship of moral courage, job-esteem, and social responsibility among disaster relief nurses. OBJECTIVE: To explore the influence of moral courage and job-esteem on the social responsibility in disaster relief nurses and clarify the relationship model between them. METHODS: A cross-sectional study was conducted among 716 disaster relief nurses from 14 hospitals in central China through an online survey, including moral courage scale, job-esteem scale, and social responsibility questionnaire. The data were analyzed by Pearson's correlation, and the mechanism of the effect of moral courage and job-esteem on social responsibility was completed. ETHICAL CONSIDERATIONS: This study was approved by the Medical Ethics Committee of the Second Xiangya Hospital of Central South University (Approval Number: 2019016). RESULTS: Disaster relief nurses' moral courage positively impacted social responsibility (r = 0.677, p < 0.01), and moral courage could affect social responsibility through the mediating role of job-esteem. CONCLUSION: Job-esteem mediated between moral courage and social responsibility among disaster relief nurses. Nursing managers regular assessment of nurses' moral courage and interventions such as meetings and workshops can reduce moral distress, foster morally courageous behavior, enhance job-esteem, and improve social responsibility performance among disaster relief nurses.

Moral courage, burnout, professional competence, and compassion fatigue among nurses.

BACKGROUND: Moral courage is the ability to defend and practice ethical and moral action when faced with a challenge, even if it means rejecting pressure to act otherwise. However, moral courage remains an unexplored concept among middle eastern nurses. AIM: This study investigated the mediating role of moral courage in the relationship between burnout, professional competence, and compassion fatigue among Saudi Arabian nurses. RESEARCH DESIGN: Correlational, cross-sectional design following the STROBE guidelines. PARTICIPANTS AND RESEARCH CONTEXT: Convenience sampling was used to recruit nurses (n = 684) for four government hospitals in Saudi Arabia. Four validated self-report questionnaires (Nurses' Moral Courage Scale, Nurse Professional Competence Scale-Short Form, Maslach Burnout Inventory, and Nurses Compassion Fatigue Inventory) were used to collect data between May to September 2022. Spearman rho and structural equation modeling analyses were employed to analyze the data. ETHICAL CONSIDERATIONS: The ethics review committee of a government university in Ha'il region, Saudi Arabia, approval this study (Protocol no.: H-2021-012; Approved: 08/022,021). Participants were fully explained the study aims, and consent was voluntarily secured. RESULTS: The emerging model showed that burnout had a direct and positive influence on compassion fatigue, while professional competence had a direct, negative effect on compassion fatigue. Moral courage had a small and direct but negative influence on compassion fatigue. Mediation analyses also indicated that moral courage significantly mediated the indirect effects of burnout and professional competence on compassion fatigue. CONCLUSION: Moral courage can be a crucial aspect in preserving the psychological and mental health of nurses, particularly under stressful conditions. Therefore, it is advantageous from an organizational and leadership standpoint to implement measures such as programs and interventions to foster moral courage among nurses.

Real-world effectiveness, satisfaction, and optimization of ubrogepant for the acute treatment of migraine in combination with onabotulinumtoxinA: results from the COURAGE Study.

BACKGROUND: Individuals using onabotulinumtoxinA as a preventive migraine treatment often use acute treatments for breakthrough attacks. Data on real-world effectiveness of the small-molecule calcitonin gene-related peptide (CGRP) receptor antagonist ubrogepant in combination with onabotulinumtoxinA are limited. METHODS: COURAGE, a prospective, multiple attack, observational study, evaluated the real-world effectiveness of ubrogepant (50 or 100 mg) for acute treatment of migraine in people receiving onabotulinumtoxinA, an anti-CGRP monoclonal antibody (mAb), or both. This analysis focused only on onabotulinumtoxinA users. The Migraine Buddy app was used to identify eligible participants and track response to treated attacks. For each ubrogepant-treated attack, meaningful pain relief (MPR) and return to normal function (RNF) at 2 and 4 h post-dose over 30 days was assessed. MPR was defined as a level of relief that is meaningful to the participant, usually occurring before the pain is all gone. After 30 days, satisfaction was reported on a 7-point scale and overall acute treatment optimization was evaluated using the migraine Treatment Optimization Questionnaire-4 (mTOQ-4). RESULTS: This analysis included 122 participants who received ubrogepant and onabotulinumtoxinA and reported on 599 ubrogepant-treated attacks. Following the first ubrogepant-treated attack, MPR was achieved in 53.3% of participants 2 h post-dose and in 76.2% of participants 4 h post-dose. RNF was achieved in 25.4% of participants 2 h post-dose and in 45.9% of participants 4 h post-dose. MPR and RNF results were similar across up to 10 ubrogepant-treated attacks. After 30 days, satisfaction with ubrogepant in combination with onabotulinumtoxinA was reported by 69.8% of participants and acute treatment optimization (defined as mTOQ-4 score ≥ 4) was achieved in 77.6%. CONCLUSIONS: In this prospective real-world effectiveness study, ubrogepant treatment in onabotulinumtoxinA users with self-identified migraine was associated with high rates of MPR and RNF at 2 and 4 h as well as satisfaction and acute treatment optimization. Although the lack of a contemporaneous control group limits causal inference, these findings demonstrate the feasibility of using a novel, app-based design to evaluate the real-world effectiveness and satisfaction of treatments.

The impact of resilience on clinical nurses' moral courage during COVID-19: A moderated mediation model of ethical climate and moral distress.

AIM: The purpose of this study was to explore whether clinical ethical climate mediates the relationship between resilience and moral courage in a population of clinical nurses during COVID-19, and if moral distress faced by nurses is a moderating factor. BACKGROUND: Resilience can help nurses maintain their personal health during COVID-19 when they face great physical and psychological shock and are prone to health problems. Moral courage, as an ethical competency, helps nursing staff in adhering to the principles and values of professional ethics. There is a strong correlation between resilience and moral courage, but the mechanism by which resilience contributes to moral courage is unclear. METHOD: A cross-sectional study research is designed. Three hundred thirty clinical nurses from six hospitals in Beijing, Sichuan, and Fujian of China were included between August 2021 and March 2022. The survey instruments include the Nurses' Moral Courage Scale (NMCS), Connor-Davidson Resilience Scale (CD-RISC), Moral Distress Scale-Revised (MDS-R), and Hospital Ethical Climate Scale (HECS). RESULTS: Ethical climate mediates 15% of the relationship between resilience and moral courage. The association between resilience and ethical climate, as well as the indirect relationship between resilience and moral courage, was modified by moral distress. DISCUSSION: This study investigated the mechanisms by which resilience affects moral courage in clinical nurses in the context of COVID-19, suggesting that moral courage can be increased by alleviating moral distress and increasing ethical climate. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study confirms the mediating effect of moral climate on the relationship between resilience and moral courage, as well as the moderating effect of moral distress. Hospital policymakers should value nurses' psychological resilience and moral courage, develop effective policies to prevent and manage stressors, build social support systems, and create a positive ethical climate.

Evaluation of moral sensitivity and moral courage in intensive care nurses in Turkey during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, intensive care nurses may experience ethical issues related to fear of transmission, limited resources, and increased workload. Nurses' moral sensitivity and courage may have a role in dealing with these problems. AIM: The purpose of this study was to assess intensive care nurses' moral sensitivity and moral courage during the COVID-19 pandemic. DESIGN: Descriptive cross-sectional survey. METHODS: A total of 362 nurses working in the intensive care units of pandemic hospitals in Turkey participated in the study between January and March 2021. Data were obtained using a personal information form, the Moral Sensitivity Questionnaire, and the Nurses' Moral Courage Scale. A link to the online data collection tools was sent to the management of participating institutions, who forwarded it to nurses. Reporting followed the CHERRIES guidelines. RESULTS: In this study, the response rate of nurses was 89%. The nurses' total mean moral sensitivity score was 90.70 ± 28.89 and their mean moral courage score was 82.08 ± 13.51. A weak inverse correlation was found between the nurses' moral sensitivity and moral courage scores (r = -.176, p = .001). Total moral sensitivity score differed significantly according to years of Intensive care unit (ICU) experience (p = .007). Total moral courage scores increased significantly with education level (p = .012), years of nursing experience (p = .016), and willingness to work in the ICU (p < .001). CONCLUSION: The study suggests that nurses working in the intensive care unit during the pandemic had moderate moral sensitivity and high levels of moral courage. Nurses' sociodemographic characteristics and ICU work conditions may affect their moral sensitivity and moral courage. RELEVANCE TO CLINICAL PRACTICE: The results of this study can help guide efforts to improve moral courage and sensitivity and address ethical issues among ICU nurses.

Developing conceptually sound items for a clinical courage questionnaire.

INTRODUCTION: Clinical courage can be described as a rural doctor's adaptability and willingness to undertake clinical work at the limits of their training and experience to meet the needs of their patients. This article describes the in-house development of survey items to include in a quantitative measure of clinical courage. METHODS: The questionnaire development involved two key concepts: a second-order latent factor model structure and a nominal group technique, used to develop consensus among the research team members. RESULTS: The steps taken to develop a sound clinical courage questionnaire are described in detail. The resulting initial questionnaire is presented, ready for testing with rural clinicians and refinement. CONCLUSION: This article outlines the psychometric process of questionnaire design and presents the resultant clinical courage questionnaire.

Moral Distress, Moral Resilience, Moral Courage, and Moral Injury Among Nurses in the Philippines During the COVID-19 Pandemic: A Mediation Analysis.

Investigations about moral resilience and moral courage as mediators between moral distress and moral injury remain underreported among nurses during the COVID-19 pandemic. Nurses (n = 412) from the Philippines were conveniently recruited via social media platforms and completed four self-report scales. The mediation model depicts that moral distress negatively impacts moral resilience and moral courage while positively affecting moral injury. Moral resilience and moral courage negatively impact moral injury, whereas moral resilience directly impacts moral courage. Finally, moral resilience and moral courage demonstrated a mediating effect between moral distress and moral injury. Findings indicate that healthcare organizations and nurse managers should nurture morally resilient and courageous therapeutic practices among frontline healthcare professionals to mitigate the negative effects of moral distress and moral injury.

The courage to change science.

Bureaucracy, performance assessment and other pressures increasingly encroach on scientists' ability to do science. The research community as a whole needs to address these perils.

Optimal Medical Therapy as First-Line Therapy for Chronic Coronary Syndromes: Lessons from COURAGE, BARI 2D, FAME 2, and ISCHEMIA.

The chronic coronary syndromes (CCS) include patients with a classic history of angina pectoris in the presence of either risk factors for or known atherosclerotic coronary artery disease. Randomized, controlled trials conducted in the optimal medical therapy (OMT) era have convincingly demonstrated that adherence to the outdated paradigm focused on treatment of obstructive coronary disease with initial revascularization fails to reduce death or myocardial infarction and inconsistently reduces angina symptoms. Rather, OMT reduces events and improves symptoms and should be considered first-line treatment for patients with CCS.

Positive personal resources and psychological distress during the COVID-19 pandemic: resilience, optimism, hope, courage, trait mindfulness, and self-efficacy in breast cancer patients and survivors.

PURPOSE: This study aims to understand the association between positive personal resources (i.e., optimism, hope, courage, trait mindfulness, and self-efficacy), resilience, and psychological distress (i.e., anxiety, depression, stress) in women with breast cancer and breast cancer survivors during the COVID-19 pandemic. We hypothesized that personal positive resources can directly influence resilience, which in turn prevented psychological distress. METHODS: The research sample consisted of 409 Italian women (49% patients, 51% survivors) who were administered a questionnaire to assess positive resources, resiliency, and distress. structural equation model (SEM) analysis was carried out to confirm the hypothetical-theoretical model. RESULTS: Personal positive resources had a direct positive effect on resilience, which prevented from distress. These results were observed across cancer patients and survivors, and regardless the level of direct exposure to COVID-19. CONCLUSIONS: In both patients and survivors, the relationships between positive personal resources, resilience, and psychological distress is strong enough to be not influenced by the level of exposure to COVID-19 and despite COVID-19 pandemic caused the disruption of active treatment plans and delays in routine check-ups. IMPLICATIONS FOR CANCER SURVIVORS: Implications of this study suggest the urgency to screen positive resources and to identify women with lower resilience and a potentially higher susceptibility to develop psychological distress. For these women, our findings suggest the implementation of psychological interventions that build resilience.

Normalising disclosure or reinforcing heroism? An exploratory critical discourse analysis of mental health stigma in medical education.

INTRODUCTION: There has been a proliferation of initiatives targeted towards improving psychological wellbeing among medical learners. Yet many learners do not seek assistance due to stigma against help seeking. Understanding the prevailing discourses on the effects of mental health stigma in the context of medical education will improve insight on how to address stigma and improve wellbeing. In this study, the authors sought to explore discourses on stigma in medical education through a Foucauldian Critical Discourse Analysis. METHODS: The authors assembled several sets of texts related to stigma in medical education. The initial archive consisted of social media discourse and was expanded to include digital news media. Next, the authors conducted semi-structured qualitative interviews with medical students, residents and faculty. Using principles of Critical Discourse Analysis informed by the writings of Michel Foucault, the authors analysed the archive to identify truth statements, representative statements and discursive effects. RESULTS: Analysis revealed an emancipatory discourse of disclosure that normalised help-seeking, which conflicted with a discourse of performance. Results suggested that public disclosure remains challenging in private contexts due to a medical culture that rewards perfectionism and lauds heroism. Discourses on performance positioned disclosure as disruptive to the system's need to maintain its own hegemony. Overall, stigma was perceived as rooted within the structural power of the medical education system and society at large. CONCLUSION: Discourses on stigma in medical education hold implications for the teaching, learning and overall wellbeing of medical learners. The tensions between discourses on disclosure and performance have the potential to perpetuate further distress for learners and worsen asymmetries in power. Interventions to address stigma would benefit from understanding and addressing the role of power and hierarchy in maintaining and dismantling stigma.

High ideals: the misappropriation and reappropriation of the heroic label in the midst of a global pandemic.

The purpose of this article is to offer an alternative, more nuanced analysis of the labelling of frontline workers as heroes than originally proposed. Here, we argue that the hero narrative in itself need not be problematic, but highlight a number of wider factors that have led to the initial rise (and subsequent fall) in support for labelling frontline workers as heroes. Through our related work, we have gathered similar stories from frontline workers where they feel betrayed, let down or otherwise short-changed by the hero label, and we have sought to make sense of this through understanding more about how the hero label is used rather than what it means. In this article, we propose a way forward where there is greater discussion around the hero label in this context where individuals can be heroes but still struggle, still fail and still feel vulnerable, and where heroism is viewed as a state of interdependence between heroic actor and the wider group. It is true that heroes can inspire, lead, guide and build morale and camaraderie, but collective responsibility is held with us all. We can draw hope and energy from our heroes, but we must dig deep and be proactive, particularly in the face of adversity. In doing so, we support the heroes to lead from the front and ensure that even though we cannot physically help; we are not making their situation worse.

'It needs experience and courage': Awareness towards end of life communication practices in oncologists: A mixed methods study.

OBJECTIVE: End of life communication (EOLC) is generally regarded as a challenging aspect of the medical profession, with high influences of culture, the physician's experience and awareness. The aim of the current study was to assess the awareness of Austrian oncologists towards EOLC practices in their daily clinical routine and to identify limiting and supporting factors of these conversations. METHODS: Overall, 45 oncologists participated in the assessment in this cross-sectional, mixed-method design using semi-structured interviews and questionnaire. RESULTS: Themes that occurred during the interviews included the initiation of EOLC, EOLC in practice, strategies for EOLC, limiting and supporting factors and consequences of EOLC. There were several variations in the EOLC approach, that is, the use of time frames, timing, initiation and the amount of details given to the patient. CONCLUSION: Oncologists agreed that EOLC is important in their daily clinical routine and for their patients. Nevertheless, there seems to be an underlying variation in approaches chosen by Austrian oncologists. This variation might be reduced by asking patients about their information preferences in advance and by routine implementation of communication guidelines, nomograms and prognostic calculators to reduce uncertainty.