Moral Distress and Coping Among Nurses in Southeast Asia: A Scoping Review of the Evidence and Its Implications for Oncology Nursing
Nancita M Pelayo, Marie Cuyopan
Abstract
Background:
Moral distress is well documented in oncology nursing, but the evidence comes largely from outside Southeast Asia, a region with a fast-growing cancer burden and constrained nursing workforces.
Objective:
To map the extent, nature, and gaps of evidence on moral distress and coping among nurses in the eleven ASEAN member states, with specific attention to oncology, palliative, and end-of-life nursing.
Methods:
We followed Joanna Briggs Institute methodology and PRISMA-ScR reporting (registration 652NO26). PubMed, CINAHL, Scopus, and PsycINFO were searched from inception to 10 October 2026, supplemented by Google Scholar, the Thai-Journal Citation Index, Garuda, and reference lists. Two reviewers screened and charted independently, and charted data were verified against the original full texts. No critical appraisal was performed, consistent with scoping review methodology.
Results:
Of 336 records identified, 258 unique records were screened and 27 reports were assessed in full. Ten reports met the eligibility criteria: Thailand (n = 4), the Philippines (n = 3), Indonesia (n = 2), and Singapore (n = 1). Only one, a qualitative study of eight senior oncology and palliative nurses in Singapore, sampled oncology or palliative nurses; it addressed value conflict and coping rather than measuring moral distress. System-level constraints and end-of-life care situations were the highest-ranked causes of moral distress in Thai mental health nurses, and moral resilience and moral courage mediated the link between moral distress and moral injury in Filipino nurses. No eligible reports were identified from the other seven ASEAN states.
Conclusions:
Evidence on moral distress among nurses in Southeast Asia is sparse, concentrated in four countries, and almost silent on oncology nurses. Priorities include oncology-specific studies with validated, language-appropriate instruments, longitudinal designs linking distress to retention, and evaluation of resilience-building interventions.