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Wang X, Ho MJ. When patient-centred and family-centred approaches clash: Taiwanese health professions students' patient autonomy dilemmas. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:1625-1640. [PMID: 34436701 DOI: 10.1007/s10459-021-10064-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 08/08/2021] [Indexed: 06/13/2023]
Abstract
The main purpose of the study was to examine whether health professions students in Taiwan who study in different programmes experience similar patient autonomy-related professionalism dilemmas caused by disconnections between school and clinical culture. To investigate this issue, we draw specifically on situated learning theory and its cultural concept to examine their professionalism dilemma narratives that were collected through interviews. Of the 79 interviewed students, nearly half of them experienced patient autonomy dilemmas caused by conflicts between school and clinical culture, which have significant negative impacts on their learning and emotional wellbeing. Four major types of patient autonomy-related dilemmas emerge from the data. It was also found that when school culture and clinical culture clash, the latter has a greater influence on students. Thus, the study argues that Taiwanese students' frequent encounters with patient-autonomy dilemmas highlight the challenges faced by health professions students in transferring knowledge between school and clinical cultures, and clinical culture has a more powerful influence on their behaviour and clinical decision making. This phenomenon should be taken into account when organizing health professions education.
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Affiliation(s)
- Xin Wang
- Department of Humanities, Jiang Nan University, No. 1800, Lihu Avenue, Wuxi, 214122, People's Republic of China
| | - Ming-Jung Ho
- Department of Family Medicine, Centre for Innovation and Leadership in Education (CENTILE), Georgetown University Medical Center, Washington, DC, 20057, USA.
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Chen YY, Cheng YF, Wu CC, Chu TS. The usage of social media encouraged patients' active participation in medical decision-making: cross-sectional survey (Preprint). J Particip Med 2018. [DOI: 10.2196/11828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ting PS, Chen L, Yang WC, Huang TS, Wu CC, Chen YY. Gender and age disparity in the initiation of life-supporting treatments: a population-based cohort study. BMC Med Ethics 2017; 18:62. [PMID: 29141641 PMCID: PMC5688717 DOI: 10.1186/s12910-017-0222-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 11/08/2017] [Indexed: 11/17/2022] Open
Abstract
Background The relationships between age and the life-supporting treatments use, and between gender and the life-supporting treatments use are still controversial. Using extracorporeal membrane oxygenation as an example of life-supporting treatments, the objectives of this study were: (1) to examine the relationship between age and the extracorporeal membrane oxygenation use; (2) to examine the relationship between age and the extracorporeal membrane oxygenation use; and (3) to deliberate the ethical and societal implications of age and gender disparities in the initiation of extracorporeal membrane oxygenation. Methods This is a population-based, retrospective cohort study. Taiwan’s extracorporeal membrane oxygenation cases from 2000 to 2010 were collected. The annual incidence rate of extracorporeal membrane oxygenation use adjusting for both age and gender distribution for each year from 2000 to 2010 was derived using the population of 2000 as the reference population. The trend of extracorporeal membrane oxygenation use was examined using time-series linear regression analysis. We conducted joinpoint regression for estimating the trend change of extracorporeal membrane oxygenation use. Results The trends of extracorporeal membrane oxygenation use both for different gender groups, and for different age groups have been significantly increasing over time. Men were more likely to be supported by extracorporeal membrane oxygenation than women. Women’s perspectives toward life and death, and women’s perception of well-being may be associated with the phenomenon. In addition, the patients at the age of 65 or older were more likely to be supported by extracorporeal membrane oxygenation than those younger than 65. Family autonomy/family-determination, and the Confucian tradition of filial piety and respecting elders may account for this phenomenon. Conclusions This study showed gender and age disparities in the initiation of extracorporeal membrane oxygenation use in Taiwan, which may be accounted for by the cultural and societal values in Taiwan. For a healthcare professional who deals with patients’/family members’ medical decision-making to initiate life-supporting treatments, he/she should be sensitive not only to the legality, but also the societal and ethical issues involved.
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Affiliation(s)
- Peng-Sheng Ting
- Department of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Likwang Chen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Wei-Chih Yang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Tien-Shang Huang
- Department of Medical Education, Cathay General Hospital, Miaoli, Taiwan
| | - Chau-Chung Wu
- Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Yuan Chen
- Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan. .,Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan.
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Yoshizawa G, Sasongko TH, Ho CH, Kato K. Social and Communicative Functions of Informed Consent Forms in East Asia and Beyond. Front Genet 2017; 8:99. [PMID: 28775738 PMCID: PMC5517404 DOI: 10.3389/fgene.2017.00099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/05/2017] [Indexed: 12/18/2022] Open
Abstract
The recent research and technology development in medical genomics has raised new issues that are profoundly different from those encountered in traditional clinical research for which informed consent was developed. Global initiatives for international collaboration and public participation in genomics research now face an increasing demand for new forms of informed consent which reflect local contexts. This article analyzes informed consent forms (ICFs) for genomic research formulated by four selected research programs and institutes in East Asia – the Medical Genome Science Program in Japan, Universiti Sains Malaysia Human Research Ethics Committee in Malaysia, and the Taiwan Biobank and the Taipei Medical University- Joint Institutional Review Board in Taiwan. The comparative text analysis highlights East Asian contexts as distinct from other regions by identifying communicative and social functions of consent forms. The communicative functions include re-contact options and offering interactive support for research participants, and setting opportunities for family or community engagement in the consent process. This implies that informed consent cannot be validated solely with the completion of a consent form at the initial stage of the research, and informed consent templates can facilitate interactions between researchers and participants through (even before and after) the research process. The social functions consist of informing participants of possible social risks that include genetic discrimination, sample and data sharing, and highlighting the role of ethics committees. Although international ethics harmonization and the subsequent coordination of consent forms may be necessary to maintain the quality and consistency of consent process for data-intensive international research, it is also worth paying more attention to the local values and different settings that exist where research participants are situated for research in medical genomics. More than simply tools to gain consent from research participants, ICFs function rather as a device of social communication between research communities and civic communities in liaison with intermediary agents like ethics committees, genetic counselors, and public biobanks and databases.
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Affiliation(s)
- Go Yoshizawa
- Graduate School of Medicine, Osaka UniversitySuita, Japan
| | - Teguh H Sasongko
- Division of Human Biology, School of Medicine, International Medical UniversityKuala Lumpur, Malaysia.,Human Research Ethics Committee, Universiti Sains Malaysia Health CampusKubang Kerian, Malaysia
| | - Chih-Hsing Ho
- Institute of European and American Studies, Academia SinicaTaipei, Taiwan
| | - Kazuto Kato
- Graduate School of Medicine, Osaka UniversitySuita, Japan
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Huang CC, Huang CC, Yang YY, Lin SJ, Chen JW. The influence of gender on the communication skills assessment of medical students. Eur J Intern Med 2015; 26:670-4. [PMID: 26160772 DOI: 10.1016/j.ejim.2015.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/12/2015] [Accepted: 06/27/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Opinions on the interaction between the genders of standardized patients and examinees are controversial. Our study sought to determine the influence of gender on communication skills assessment in Eastern country. METHODS We recruited year 5 medical students from a medical college in Taiwan. They were assigned to obtain informed consent from either male or female age-matched standardized patients. Their performance was rated by standardized checklist rating scores and global rating scores. Either male or female examiners rated their performance. RESULTS A total of 253 medical students (166 male students and 87 female students) were recruited. The checklist rating scores for students interacting with male standardized patients were significantly lower than the scores for interactions with female standardized patients (male examiners, P=0.006; female examiners, P=0.001). For male students, the checklist rating scores were significantly lower for male standardized patients than for female standardized patients (male examiners, P=0.006; female examiners, P=0.008). For male standardized patients, male students had significantly lower checklist rating scores than female students when rated by male examiners (P=0.044). The global rating scores were similar except when female students interacted with male and female SPs and when rated by female examiners (P=0.004). CONCLUSION The gender of standardized patients influences communication skills assessment. In terms of checklist rating scores, female standardized patients seem preferable to minimize potential gender effects. In the best interest of students, global rating score may be preferable to checklist rating score, especially for male examinees.
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Affiliation(s)
- Chin-Chou Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chia-Chang Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Ying-Ying Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Shing-Jong Lin
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Jaw-Wen Chen
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, R.O.C..
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Yoshizawa G, Ho CWL, Zhu W, Hu C, Syukriani Y, Lee I, Kim H, Tsai DFC, Minari J, Kato K. ELSI practices in genomic research in East Asia: implications for research collaboration and public participation. Genome Med 2014; 6:39. [PMID: 24944586 PMCID: PMC4062049 DOI: 10.1186/gm556] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Common infrastructures and platforms are required for international collaborations in large-scale human genomic research and policy development, such as the Global Alliance for Genomics and Health and the 'ELSI 2.0' initiative. Such initiatives may require international harmonization of ethical and regulatory requirements. To enable this, however, a greater understanding of issues and practices that relate to the ethical, legal and social implications (ELSI) of genomic research will be needed for the different countries and global regions involved in such research. Here, we review the ELSI practices and regulations for genomic research in six East Asian countries (China, Indonesia, Japan, Singapore, South Korea and Taiwan), highlighting the main similarities and differences between these countries, and more generally, in relation to Western countries. While there are significant differences in ELSI practices among these East Asian countries, there is a consistent emphasis on advancing genomic science and technology. In addition, considerable emphasis is placed on informed consent for participation in research, whether through the contribution of tissue samples or personal information. However, a higher level of engagement with interested stakeholders and the public will be needed in some countries.
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Affiliation(s)
- Go Yoshizawa
- Department of Biomedical Ethics and Public Policy, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Calvin Wai-Loon Ho
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Republic of Singapore
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK
| | - Wei Zhu
- Department of Social Sciences, Fudan University, 220 Handan Road, Shanghai 200433, China
| | - Chingli Hu
- Office of the President, Shanghai Jiaotong University School of Medicine, 227 Chongqing Road, Shanghai 200025, China
| | - Yoni Syukriani
- Department of Forensic and Legal Medicine, Faculty of Medicine, Padjadjaran University, Jl. Eijkman 38, Bandung 40161, Indonesia
| | - Ilhak Lee
- Center for ELSI Research, Asian Institute for Bioethics and Health Law, Department of Medical Law and Ethics, College of Medicine, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul 120-749, South Korea
| | - Hannah Kim
- Center for ELSI Research, Asian Institute for Bioethics and Health Law, Department of Medical Law and Ethics, College of Medicine, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul 120-749, South Korea
| | - Daniel Fu Chang Tsai
- Department of Social Medicine, National Taiwan University College of Medicine, 1 Section 1, Jen-Ai Road, Taipei 100, Taiwan
| | - Jusaku Minari
- Department of Biomedical Ethics and Public Policy, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kazuto Kato
- Department of Biomedical Ethics and Public Policy, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
- Institute for Integrated Cell-Material Sciences (iCeMS), Kyoto University, Yoshida Ushinomiya-cho, Sakyo-ku, Kyoto 606-8501, Japan
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To evaluate the effectiveness of health care ethics consultation based on the goals of health care ethics consultation: a prospective cohort study with randomization. BMC Med Ethics 2014; 15:1. [PMID: 24387594 PMCID: PMC3898237 DOI: 10.1186/1472-6939-15-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/30/2013] [Indexed: 11/22/2022] Open
Abstract
Background The growing prevalence of health care ethics consultation (HCEC) services in the U.S. has been accompanied by an increase in calls for accountability and quality assurance, and for the debates surrounding why and how HCEC is evaluated. The objective of this study was to evaluate the effectiveness of HCEC as indicated by several novel outcome measurements in East Asian medical encounters. Methods Patients with medical uncertainty or conflict regarding value-laden issues, and requests made by the attending physicians or nurses for HCEC from December 1, 2009 to April 30, 2012 were randomly assigned to the usual care group (UC group) and the intervention group (HCEC group). The patients in the HCEC group received HCEC conducted by an individual ethics consultant. Data analysis was based on the intention-to-treat principle. Mann–Whitney test and Chi-squared test were used depending on the scale of measurement. Results Thirty-three patients (53.23%) were randomly assigned to the HCEC group and 29 patients were randomly assigned to the UC group. Among the 33 patients in the HCEC group, two (6.06%) of them ultimately did not receive a HCEC service. Among the 29 patients in the UC group, four (13.79%) of them received a HCEC service. The survival rate at hospital discharge did not differ between the two groups. Patients in the HCEC group showed significant reductions in the entire ICU stay and entire hospital stay. HCEC significantly facilitated achieving the goal of medical care (p < .01). Furthermore, patients in the HCEC group had a shorter ICU stay and shorter hospital stay after the occurrence of medical uncertainty or conflict regarding value-laden issues than those in the UC group. Conclusions Our findings demonstrated that HCEC were associated with reduced consumption of medical resources as indicated by shorter entire ICU stay, entire hospital stay, and shorter ICU and hospital stay after the occurrence of the medical uncertainty or conflict regarding value-laden issues. This study also showed that HCEC facilitated achieving a consensus regarding the goal of medical care, which conforms to the goal of HCEC.
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