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Ahmed S, Jafri H, Faran M, Ahmed WN, Rashid Y, Ehsan Y, Ahmed M. Cascade screening for beta-thalassaemia in Pakistan: relatives' experiences of a decision support intervention in routine practice. Eur J Hum Genet 2022; 30:406-412. [PMID: 34608271 PMCID: PMC8991204 DOI: 10.1038/s41431-021-00974-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022] Open
Abstract
Low uptake of cascade screening for βeta-thalassaemia major (β-TM) in the 'Punjab Thalassaemia Prevention Project' (PTPP) in Pakistan led to the development of a 'decision support intervention for relatives' (DeSIRe). This paper presents the experiences of relatives of children with β-TM of the DeSIRe following its use by PTPP field officers (FOs) in routine clinical practice. Fifty-four semi-structured qualitative interviews were conducted (April to June 2021) with relatives in seven cities in the Punjab province (Lahore, Sheikhupura, Nankana Sahab, Kasur, Gujranwala, Multan and Faisalabad). Thematic analysis shows that participants were satisfied with the content of the DeSIRe and its delivery by the FOs in a family meeting. They understood that the main purpose of the DeSIRe was to improve their knowledge of β-TM and its inheritance, and to enable them to make decisions about thalassaemia carrier testing, particularly before marriage. Participants also raised concerns about the stigma of testing positive; however, they believed the DeSIRe was an appropriate intervention, which supported relatives to make informed decisions. Our findings show that the DeSIRe is appropriate for use by healthcare professionals in routine practice in a low-middle income country, and has the potential to facilitate shared decision making about cascade screening for thalassaemia. Further research is needed to prove the efficacy of the DeSIRe.
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Affiliation(s)
- Shenaz Ahmed
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Hussain Jafri
- Thalassaemia Society Pakistan, Lahore, Pakistan
- Fatima Jinnah Medical University, Lahore, Pakistan
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Elafros MA, Belessiotis-Richards C, Birbeck GL, Bond V, Sikazwe I, Kvalsund MP. A qualitative study of patient, caregiver, doctor and nurse views of factors influencing lumbar puncture uptake in Zambia. Trans R Soc Trop Med Hyg 2021; 116:322-327. [PMID: 34352890 PMCID: PMC8978296 DOI: 10.1093/trstmh/trab124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/19/2021] [Accepted: 07/21/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Uptake of lumbar puncture (LP) remains low in regions with a high prevalence of central nervous system (CNS) infections like Zambia. Efforts to improve uptake are hindered by limited understanding of factors influencing LP uptake. METHODS Semistructured qualitative interviews were conducted with patients with suspected CNS infection, caregivers, doctors and nurses at the University Teaching Hospitals in 2016. Questions focused on LP experiences, knowledge, the consent process and health system barriers to LP among patients with an LP indication. Interviews were transcribed, translated to English and analysed using a thematic approach. RESULTS We recruited 24 adult patients, 36 caregivers of adult patients, 63 caregivers of paediatric patients, 20 doctors and 30 nurses (173 in total). LP barriers arose from both patients/caregivers and health providers and included community apprehension about LP, proxy (family) consensus consent practices, competing clinical demands, wariness of patient/caregiver responses, limitations in consumables and time to complete the LP. This could result in consent not being obtained correctly. LP enablers included patient/caregiver perceived LP utility, provider comfort with LP and in-person counselling. CONCLUSIONS LP uptake is a complex sociocultural process influenced by patient, healthcare and community-level factors. Interventions to improve uptake must address multiple barriers to be successful.
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Affiliation(s)
- Melissa A Elafros
- Department of Neurology, University of Michigan, Ann Arbor, MI 48105, USA
| | - Clara Belessiotis-Richards
- Department of Psychiatry, University College London, London, W1T 7BN, UK.,Camden and Islington NHS Foundation Trust, London, NW1 OPE, UK
| | - Gretchen L Birbeck
- Department of Neurology, University of Rochester, Rochester, NY 14642, USA.,Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, 10101, Zambia.,University Teaching Hospitals, Children's Hospital, Lusaka, 10101, Zambia
| | - Virginia Bond
- Zambart, School of Public Health, University of Zambia, Lusaka, 10101, Zambia.,Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, 10101, Zambia
| | - Michelle P Kvalsund
- Department of Neurology, University of Rochester, Rochester, NY 14642, USA.,Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, 10101, Zambia
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Negash M, Chanyalew M, T Gebresilase T, Sintayehu B, Anteye T, Aseffa A, Newport MJ. Rapid ethical appraisal of stakeholder views on research prior to undertaking immunopathogenesis studies on podoconiosis in northeast Ethiopia during a period of social instability. Trans R Soc Trop Med Hyg 2021; 115:1026-1038. [PMID: 33570141 PMCID: PMC8417087 DOI: 10.1093/trstmh/trab003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/24/2020] [Accepted: 01/12/2021] [Indexed: 11/26/2022] Open
Abstract
Background Undertaking research and attaining informed consent can be challenging when there is political unrest and community mistrust. Rapid ethical appraisal (REA) is a tool that uses qualitative methods to explore sociocultural issues that may affect the ethical conduct of research. Methods We used REA in northeast Ethiopia shortly following a period of unrest, during which violence against researchers occurred, to assess stakeholder perceptions of research, researchers and the informed consent process. We held 32 in-depth interviews and 2 focus group discussions. Results Most community members had little awareness about podoconiosis or healthcare research. Convincing the community to donate blood for research is challenging due to association with HIV testing. The attack on researchers was mainly motivated by the community's mistrust of their intentions against the background of a volatile political situation. Social media contributed to the spread of misinformation. Lack of community engagement was also a key contributing factor. Conclusions Using REA, we identified potential barriers to the informed consent process, participant recruitment for data and specimen collection and the smooth conduct of research. Researchers should assess existing conditions in the study area and engage with the community to increase awareness prior to commencing their research activities.
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Affiliation(s)
- Mikias Negash
- Brighton and Sussex Centre for Global Health Research , Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,Armauer Hansen Research Institute, Addis Ababa, Ethiopia.,Addis Ababa University, College of Health Sciences, Department of Medical Laboratory Science, Addis Ababa, Ethiopia
| | | | - Tewodros T Gebresilase
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.,Unit of Health Biotechnology, Institute of Biotechnology, College of Natural and Computational Sciences, Addis Ababa University, Ethiopia
| | | | | | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Melanie J Newport
- Brighton and Sussex Centre for Global Health Research , Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
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Malik AY, Conroy M. Virtues and Phronesis: Making Decisions in the Clinical Context. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:73-74. [PMID: 32116172 DOI: 10.1080/15265161.2020.1714803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Gabay G, Bokek-Cohen Y. Infringement of the right to surgical informed consent: negligent disclosure and its impact on patient trust in surgeons at public general hospitals - the voice of the patient. BMC Med Ethics 2019; 20:77. [PMID: 31660956 PMCID: PMC6819415 DOI: 10.1186/s12910-019-0407-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 09/06/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is little dispute that the ideal moral standard for surgical informed consent calls for surgeons to carry out a disclosure dialogue with patients before they sign the informed consent form. This narrative study is the first to link patient experiences regarding the disclosure dialogue with patient-surgeon trust, central to effective recuperation and higher adherence. METHODS Informants were 12 Israelis (6 men and 6 women), aged 29-81, who underwent life-saving surgeries. A snowball sampling was used to locate participants in their initial recovery process upon discharge. RESULTS Our empirical evidence indicates an infringement of patients' right to receive an adequate disclosure dialogue that respects their autonomy. More than half of the participants signed the informed consent form with no disclosure dialogue, and thus felt anxious, deceived and lost their trust in surgeons. Surgeons nullified the meaning of informed consent rather than promoted participants' moral agency and dignity. DISCUSSION Similarity among jarring experiences of participants led us to contend that the conduct of nullifying surgical informed consent does not stem solely from constraints of time and resources, but may reflect an underlying paradox preserving this conduct and leading to objectification of patients and persisting in paternalism. We propose a multi-phase data-driven model for informed consent that attends to patients needs and facilitates patient trust in surgeons. CONCLUSIONS Patient experiences attest to the infringement of a patient's right to respect for autonomy. In order to meet the prima facie right of respect for autonomy, moral agency and dignity, physicians ought to respect patient's needs. It is now time to renew efforts to avoid negligent disclosure and implement a patient-centered model of informed consent.
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Affiliation(s)
- Gillie Gabay
- Behavioral Sciences and Psychology, College of Management Academci studies, 7 Rabin Blvd, 97150 Rishon Letzion, Israel
| | - Yaarit Bokek-Cohen
- Nursing Sciences, Tal-Aviv Jaffa Academic College, 7 Rabin Blvd, 97150 Rishon Letzion, Israel
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Ahmed S, Jafri H, Rashid Y, Yi H, Dong D, Zhu J, Ahmed M. Autonomous decision-making for antenatal screening in Pakistan: views held by women, men and health professionals in a low-middle income country. Eur J Hum Genet 2019; 27:848-856. [PMID: 30718884 DOI: 10.1038/s41431-019-0353-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/17/2018] [Accepted: 01/11/2019] [Indexed: 12/13/2022] Open
Abstract
Prenatal genetic technologies now are being implemented in LMICs, and while there is much research on the ethical, legal and social implications of such technologies in Western countries, there is a paucity of such research in LMICs, which have diverse cultural, religious, political, financial and health service contexts. This study aimed to explore views about women's autonomous decision-making for antenatal screening held by women, men and healthcare professionals (HCPs) in Pakistan. A Q-methodology study was conducted during June 2016 to January 2018 in Lahore, Pakistan. A total of 137 participants (60 women, 57 men, 20 HCPs) rank-ordered 41 statements. Following by-person factor analysis, four distinct viewpoints were identified. Three of these represent views held by women and men only: autonomous decision-making requires directive advice from doctors; autonomous decision-making requires the husband's involvement, where independent decision-making by the woman is considered culturally inappropriate; and opting for antenatal screening is a foregone decision. One contrasting viewpoint represents predominantly HCPs: autonomous decision-making is the couple's responsibility. These findings highlight that Western approaches to facilitating women's autonomy for antenatal screening are unlikely to be suitable for use in Pakistan. Instead, culturally appropriate practice guidelines are needed in LMICs to enable HCPs to adopt shared decision-making approaches in a way that enables them to facilitate active and joint decision-making by couples, while ensuring women exercise their autonomy.
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Affiliation(s)
| | | | | | - Huso Yi
- National University of Singapore, Singapore, Singapore
| | - Dong Dong
- Chinese University of Hong Kong, Shatin, New Territories, China
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Pan X, Zhang A, Henderson GE, Rennie S, Liu C, Cai W, Wu F, Tucker JD. Traditional, complementary, and alternative medical cures for HIV: rationale and implications for HIV cure research. Glob Public Health 2019; 14:152-160. [PMID: 29237332 PMCID: PMC6092229 DOI: 10.1080/17441692.2017.1413122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Traditional, complementary, and alternative medicine (TCAM) has been used by some people living with HIV (PLHIV) in an attempt to cure HIV. This article reviews the main factors influencing their decision to choose TCAM to cure HIV and discusses implications for HIV cure research. Those who decide to pursue traditional, complementary, and alternative medical cures may be influenced by the health system, cultural, and social dynamics, and their own individual beliefs and preferences. These same factors may impact participation in HIV cure research. People who search for traditional, complementary, and alternative medical cures may face special challenges as they are recruited, consented, and retained within HIV cure research studies. To address these potential challenges, we have suggested solutions focusing on culturally tailored communication and education, formative social science research, and community partnerships with key stakeholders. The social conditions that have promoted traditional, complementary and alternative medical cures will likely impact how PLHIV participate and experience HIV remission trials. Despite the potential challenges, it will be crucial to involve those who have previously sought out traditional cures for HIV in HIV cure research.
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Affiliation(s)
- Xin Pan
- University of North Carolina Project-China, Guangzhou, China
| | - Alice Zhang
- University of North Carolina Project-China, Guangzhou, China
- University of Maryland School of Medicine, Baltimore, USA
| | - Gail E. Henderson
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stuart Rennie
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Chuncheng Liu
- University of North Carolina Project-China, Guangzhou, China
| | - Weiping Cai
- Department of Infectious Diseases, Guangzhou Eighth People’s Hospital, Guangzhou, China
| | - Feng Wu
- University of North Carolina Project-China, Guangzhou, China
| | - Joseph D. Tucker
- University of North Carolina Project-China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Abstract
The Declaration of Helsinki, adopted by the World Medical Association's General Assembly in 1964, is the most important set of guidelines about research on human participants. It both reflects and shapes the ethos of international research ethics. It is a living instrument and is reviewed and revised regularly. Its latest revision was in 2013. There are four substantial changes, reflected in the new Paragraph 15 (which deals with compensation for trial related injuries), Paragraph 33 (relating to placebos), Paragraph 20 (relating to vulnerable groups) and the new Paragraph 34 (relating to post-trial provisions). This article analyses these changes, and asks whether they indicate any shift in the overall philosophy of the Declaration. We conclude that these changes, though significant, are not tectonic. They accord with the spirit that has motivated the Declaration through all its iterations, and indicate a steady, incremental evolution towards a holistic code of research ethics for research on human participants. Patient autonomy, though crucial, is no longer the only concern of the Declaration; distributive justice and beneficence are motivating forces too. While the Declaration is aware of the need to facilitate research, it is equally aware of the need to protect the vulnerable, and of the practical difficulties involved in that protection.
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Affiliation(s)
- Aisha Y Malik
- Department for Continuing Education, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Charles Foster
- Green Templeton College Oxford, United Kingdom of Great Britain and Northern Ireland
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Malik AY. Different Context, Similar Motives: External Influences on Motivation. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2015; 15:26-28. [PMID: 26575809 DOI: 10.1080/15265161.2015.1088975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Kengne-Ouafo JA, Nji TM, Tantoh WF, Nyoh DN, Tendongfor N, Enyong PA, Newport MJ, Davey G, Wanji S. Perceptions of consent, permission structures and approaches to the community: a rapid ethical assessment performed in North West Cameroon. BMC Public Health 2014; 14:1026. [PMID: 25277694 PMCID: PMC4195877 DOI: 10.1186/1471-2458-14-1026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 09/23/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Understanding local contextual factors is important when conducting international collaborative studies in low-income country settings. Rapid ethical assessment (a brief qualitative intervention designed to map the ethical terrain of a research setting prior to recruitment of participants), has been used in a range of research-naïve settings. We used rapid ethical assessment to explore ethical issues and challenges associated with approaching communities and gaining informed consent in North West Cameroon. METHODS This qualitative study was carried out in two health districts in the North West Region of Cameroon between February and April 2012. Eleven focus group discussions (with a total of 107 participants) were carried out among adult community members, while 72 in-depth interviews included health workers, non-government organisation staff and local community leaders. Data were collected in English and pidgin, translated where necessary into English, transcribed and coded following themes. RESULTS Many community members had some understanding of informed consent, probably through exposure to agricultural research in the past. Participants described a centralised permission-giving structure in their communities, though there was evidence of some subversion of these structures by the educated young and by women. Several acceptable routes for approaching the communities were outlined, all including the health centre and the Fon (traditional leader). The importance of time spent in sensitizing the community and explaining information was stressed. CONCLUSIONS Respondents held relatively sophisticated understanding of consent and were able to outline the structures of permission-giving in the community. Although the structures are unique to these communities, the role of certain trusted groups is common to several other communities in Kenya and Ethiopia explored using similar techniques. The information gained through Rapid Ethical Assessment will form an important guide for future studies in North West Cameroon.
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Affiliation(s)
- Jonas A Kengne-Ouafo
- />Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon
- />Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
| | - Theobald M Nji
- />Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
- />Department of Sociology and Anthropology, University of Buea, PO Box 63, Buea, Cameroon
| | - William F Tantoh
- />Department of Sociology and Anthropology, University of Buea, PO Box 63, Buea, Cameroon
| | - Doris N Nyoh
- />Department of Sociology, University of Douala, Douala, Cameroon
| | - Nicholas Tendongfor
- />Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon
- />Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
| | - Peter A Enyong
- />Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon
- />Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
| | - Melanie J Newport
- />Wellcome Trust Centre for Global Health Research, Brighton & Sussex Medical School, Falmer Campus, Brighton, BN1 9PX UK
| | - Gail Davey
- />Wellcome Trust Centre for Global Health Research, Brighton & Sussex Medical School, Falmer Campus, Brighton, BN1 9PX UK
| | - Samuel Wanji
- />Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon
- />Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
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