Caring for patients with multimorbidity: moral distress and life satisfaction among doctors and nurses in Portugal

Background The prevalence of multimorbidity (MM), defined as the co-occurrence of two or more chronic conditions in an individual, presents complex challenges for healthcare providers (HCPs). In Portugal, nearly half of the general population experiences MM, intensifying demands on HCPs. Doctors and nurses often encounter fragmented care pathways, inadequate guidelines, and frequent ethical dilemmas, which can lead to moral distress (MD). MD arises when HCPs are unable to act in accordance with their ethical beliefs due to institutional barriers, and it has consequences for well-being and employee tenure. This study aims to examine whether MM-related clinical work and life satisfaction are associated with MD among HCPs who regularly care for patients with MM. Methods Cross-sectional study surveyed doctors and nurses employed in hospital and non-hospital healthcare facilities in Portugal between August and October 2024. Data were collected using an anonymous electronic questionnaire including validated instruments: the Portuguese version of Measure of Moral Distress for Healthcare Professionals (MMD-HP) and the Satisfaction With Life Scale (SWLS). Additional sociodemographic and work-related information was gathered, including sex, age, marital status, professional role, workplace setting, number of years working with patients with MM (professional experience), and the number of patients with MM seen per week (clinical workload). Associations were examined using linear multiple regression, with the significance level set at 0.05. Results A total of 340 HCPs participated, mostly women (83.2%), nurses (66.8%), and professionals with more than 10 years of experience caring for patients with MM (75.6%). The median MD (MMD-HP) score was 128 (Q1, Q3: 73, 182); median life satisfaction (SWLS) score was 24 (Q1, Q3: 18, 28). MD was negatively correlated with life satisfaction, indicating that lower life satisfaction was associated with higher MD. Higher MD levels were observed in HCPs under 35 years compared with those over 50 ( p = 0.010). HCPs with more than 10 years of experience caring for patients with MM reported significantly lower MD ( p = 0.022). A higher MM-related clinical workload was also associated with greater MD ( p = 0.003). HCPs currently considering leaving their position due to MD reported significantly higher MD and lower life satisfaction (both p < 0.0001). In multivariable analysis, MM-related clinical workload and life satisfaction remained significant predictors of MD. Discussion MD was associated with higher MM-related clinical workload and lower life satisfaction. Younger and less experienced HPCs appeared particularly vulnerable. The reliability of these findings should be interpreted with caution due to the use of composite scores and the observational study design . The results reinforce concerns about the impact of MD on intentions to leave healthcare positions and emphasize the need for institutional support/interventions that address workload and promote well-being.