1
|
Nanyonga MM, Kutyabami P, Kituuka O, Sewankambo NK. Exploration of clinical ethics consultation in Uganda: a case study of Uganda Cancer Institute. BMC Med Ethics 2024; 25:87. [PMID: 39123154 PMCID: PMC11312825 DOI: 10.1186/s12910-024-01085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Globally, healthcare providers (HCPs), hospital administrators, patients and their caretakers are increasingly confronted with complex moral, social, cultural, ethical, and legal dilemmas during clinical care. In high-income countries (HICs), formal and informal clinical ethics support services (CESSs) have been used to resolve bioethical conflicts among HCPs, patients, and their families. There is limited evidence about mechanisms used to resolve these issues as well as experiences and perspectives of the stakeholders that utilize them in most African countries including Uganda. METHODS This phenomenological qualitative study utilized in-depth interviews (IDIs) and focus group discussions (FGDs) to collect data from Uganda Cancer Institute (UCI) staff, patients, and caretakers who were purposively selected. Data was analyzed deductively and inductively yielding themes and sub-themes that were used to develop a codebook. RESULTS The study revealed there was no formal committee or mechanism dedicated to resolving ethical dilemmas at the UCI. Instead, ethical dilemmas were addressed in six forums: individual consultations, tumor board meetings, morbidity and mortality meetings (MMMs), core management meetings, rewards and sanctions committee meetings, and clinical departmental meetings. Participants expressed apprehension regarding the efficacy of these fora due to their non-ethics related agendas as well as members lacking training in medical ethics and the necessary experience to effectively resolve ethical dilemmas. CONCLUSION The fora employed at the UCI to address ethical dilemmas were implicit, involving decisions made through various structures without the guidance of personnel well-versed in medical or clinical ethics. There was a strong recommendation from participants to establish a multidisciplinary clinical ethics committee comprising members who are trained, skilled, and experienced in medical and clinical ethics.
Collapse
Affiliation(s)
- Mayi Mayega Nanyonga
- College of Health Sciences, School of Medicine, Department of Anatomy, Makerere University, Kampala, Uganda.
- Joint Clinical Research Center, Lubowa, Kampala, Uganda.
| | - Paul Kutyabami
- College of Health Sciences, School of Health Sciences, Department of Pharmacy, Makerere University, Kampala, Uganda
| | - Olivia Kituuka
- College of Health Sciences, School of Medicine, Department of Surgery, Makerere University, Kampala, Uganda
| | - Nelson K Sewankambo
- College of Health Sciences, School of Medicine, Department of Medicine, Makerere University, Kampala, Uganda
| |
Collapse
|
2
|
Noun D, Obeid A, Belgaumi A, Sidhom I, Jadiry MA, Al-Saeed R, Khalifa N, Trehan A, Ghanem K, AbdelHafeez H, Rodriguez-Galindo C, Jeha S, Saab R. A regional virtual case discussion forum in pediatric oncology: Experience of the Pediatric Oncology East and Mediterranean Group. Pediatr Blood Cancer 2024; 71:e30838. [PMID: 38149824 DOI: 10.1002/pbc.30838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/08/2023] [Accepted: 12/18/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND The Pediatric Oncology East and Mediterranean (POEM) group that aims to share expertise among pediatric oncology providers across the Middle East, North Africa, and East Asia region initiated a virtual Case Discussion Forum (CDF) in 2013. METHODS Meeting records from September 2013 till June 2021 were reviewed. Detailed minutes were available starting August 2016; case data were analyzed including diagnoses, purpose of presentation and recommendations. A 38-item survey assessing perception of benefits, challenges, and opportunities of the forum was distributed to members of the POEM group and results analyzed. RESULTS A total of 140 cases were presented from 14 countries. After August 2016, 67 cases were presented, and those were analyzed regarding reasons for discussion, barriers, and recommendations. Details are presented in this report, and the most common challenges identified were related to histopathologic/molecular diagnosis (24%), imaging interpretation (18%), resource limitations (12%), and surgical difficulties (9%). A survey was distributed to all POEM members in 28 countries, and 76 responded. The main benefit reported was the provision of recommendations regarding treatment and evaluation, while the main challenges reported were time zone difference and workload. Recognized opportunities included conducting regionally relevant research studies based on clinical problems identified during discussions, and setting guidelines for resource-adapted treatment regimens. CONCLUSIONS The POEM CDF identified areas for multi-institutional regional studies and led to a twinning project between two centers in the region for improving diagnostic infrastructure. Such forums can identify specific resource limitations in pediatric cancer and direct efforts for targeted capacity building.
Collapse
Affiliation(s)
- Dolly Noun
- Children's Cancer Institute, Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anas Obeid
- Children's Cancer Institute, Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Asim Belgaumi
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Iman Sidhom
- Pediatric Oncology Department, National Cancer Institute, Cairo University and Children Cancer Hospital Egypt, Cairo, Egypt
| | - Mazin Al Jadiry
- Department of Pediatrics, Oncology Unit, Children Welfare Teaching Hospital, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Raghad Al-Saeed
- Department of Pediatrics, Oncology Unit, Children Welfare Teaching Hospital, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Nisreen Khalifa
- Pediatric Hematology Oncology Unit, National Bank of Kuwait Specialized Hospital for Children, Sabah, Kuwait
| | - Amita Trehan
- Pediatric Hematology Oncology Unit, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Khaled Ghanem
- BASMA Pediatric Oncology Unit, Al Bayrouni Hospital, Damascus, Syria
| | - Hafeez AbdelHafeez
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Sima Jeha
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Raya Saab
- Children's Cancer Institute, Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics, Stanford University, Palo Alto, California, USA
| |
Collapse
|
3
|
Nanyonga MM, Kutyabami P, Kituuka O, Sewankambo NK. Exploration of Clinical Ethics Consultation in Uganda: A case study of Uganda Cancer Institute. RESEARCH SQUARE 2024:rs.3.rs-3853569. [PMID: 38343843 PMCID: PMC10854307 DOI: 10.21203/rs.3.rs-3853569/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Introduction Globally, healthcare providers (HCPs), hospital administrators, patients and their caretakers are increasingly confronted with complex moral, social, cultural, ethical, and legal dilemmas during clinical care. In high-income countries (HICs), formal and informal clinical ethics support services (CESS) have been used to resolve bioethical conflicts among HCPs, patients, and their families. There is limited evidence of mechanisms used to resolve these issues as well as experiences and perspectives of the stakeholders that utilize them in most African countries including Uganda. Methodology This qualitative study utilized in-depth-interviews (IDIs) and focus group discussions (FGDs) to collect data from Uganda Cancer Institute (UCI) staff, patients, and caretakers, who were purposively selected. Data was analyzed deductively and inductively yielding themes and sub-themes that were used to develop a codebook. Results There was no formal committee nor mechanism utilized to resolve ethical dilemmas at the UCI. The study uncovered six fora where ethical dilemmas were addressed: individual consultations, tumor board meetings, morbidity and mortality meetings, core management meetings, rewards and sanctions committee meetings, and clinical departmental meetings. Participants expressed apprehension regarding the efficacy of these fora due to their non-ethics related agendas as well as members lacking training in medical ethics and the necessary experience to effectively resolve ethical dilemmas. Conclusion The fora employed at the UCI to address ethical dilemmas were implicit, involving decisions made through various structures without the guidance of personnel well-versed in medical or clinical ethics. There was a strong recommendation from participants to establish a multidisciplinary clinical ethics committee comprising members who are trained, skilled, and experienced in medical and clinical ethics.
Collapse
|
4
|
Abdul Rehman M, Naeem U, Rani A, Banatwala UESS, Salman A, Abdullah Khalid M, Ikram A, Tahir E. How well does the virtual format of oncology multidisciplinary team meetings work? An assessment of participants' perspectives and limitations: A scoping review. PLoS One 2023; 18:e0294635. [PMID: 37972143 PMCID: PMC10653537 DOI: 10.1371/journal.pone.0294635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Virtual multidisciplinary team meetings (VMDTM) provide a standard of care that is not limited by physical distance or social restrictions. And so, when the COVID-19 pandemic imposed irrefutable social restrictions and made in-person meetings impossible, many hospitals switched to the VMDTMs. Although the pandemic might have highlighted the ease of VMDTMs, these virtual meetings have existed over the past decade, albeit less in importance. Despite their recent importance, no review has previously assessed the feasibility of VMDTMs through the eyes of the participants, the barriers participants face, nor their comparison with the in-person format. We undertook this scoping review to map existing literature and assess the perspectives of VMDTM participants. MATERIAL AND METHODS We searched MEDLINE, Embase, CINAHL, and Google Scholar from inception till July 1st, 2023 to select studies that evaluated the perspectives of participants of VMDTMs regarding the core components that make up a VMDMT. Four authors, independently, extracted data from all included studies. Two authors separated data into major themes and sub-themes. RESULTS We identified six core, intrinsic aspects of a VMDTM that are essential to its structure: (1) organization, (2) case discussion and decision-making, (3) teamwork and communication, (4) training and education, (5) technology, and (6) patient-related aspect. VMDTMs have a high overall satisfaction rating amongst participants. The preference, however, is for a hybrid model of multidisciplinary teams. VMDTMs offer support to isolated physicians, help address complex cases, and offer information that may not be available elsewhere. The periodical nature of VMDTMs is appropriate for their consideration as CMEs. Adequate technology is paramount to the sustenance of the format. CONCLUSION VMDTMs are efficient and offer a multidisciplinary consensus without geographical limitations. Despite certain technical and social limitations, VMDTM participants are highly satisfied with the format, although the preference lies with a hybrid model.
Collapse
Affiliation(s)
- Muhammad Abdul Rehman
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Unaiza Naeem
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Anooja Rani
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Afia Salman
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Abdullah Khalid
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Areeba Ikram
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Erfa Tahir
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| |
Collapse
|