Beyond burnout: professional grief and moral distress in pediatric neuro-oncological neurosurgery.
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OBJECTIVE: Pediatric neuro-oncology exposes healthcare professionals to high technical complexity, ethical uncertainty, and sustained emotional stress. Professional grief, moral distress, and second victim experiences are increasingly recognized in pediatric oncology, yet they remain insufficiently characterized in pediatric neuro-oncological neurosurgery. METHODS: The authors conducted a cross-sectional, anonymous survey among healthcare professionals involved in pediatric neuro-oncology at a tertiary children's hospital. A 27-item questionnaire assessed 5 domains: professional grief, moral distress, second victim/emotional impact, neuro-oncology-specific emotional burden, and organizational support. The Pediatric Neuro-Oncology Professional Grief Score (PNOP-GS; range 27-135) was calculated as the sum of all items. Descriptive statistics, internal consistency analyses, and exploratory comparisons by training and exposure were performed. RESULTS: Forty-one complete responses were analyzed. Participants included nurses (46.3%), physicians (41.5%), and psychologists (9.8%), with 87.8% reporting exposure to children with advanced or terminal brain tumors in the preceding 12 months. The mean PNOP-GS was 91.2 ± 18.2, corresponding to a mean item score of 3.38 ± 0.67. Neuro-oncology-specific emotional burden (3.57 ± 0.96) and professional grief (3.42 ± 0.88) were the highest-scoring domains, while perceived organizational support was low (1.83 ± 0.78). Prior training in pediatric palliative care, communication of poor prognosis, or grief management was associated with significantly lower emotional burden (p = 0.002). Greater exposure to terminal cases correlated with higher PNOP-GSs (p = 0.049). Emotional burden did not differ significantly across professional roles. Internal consistency of the overall instrument was good (Cronbach's α = 0.82). CONCLUSIONS: Healthcare professionals in pediatric neuro-oncology experience substantial professional grief and emotional burden extending beyond patient death to ethical complexity and neurological morbidity. Training and organizational support represent modifiable protective factors and should be systematically integrated into pediatric neuro-oncological practice.