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Yang X, Chen C, Geng K, Jia X, Si F, Lu X, Zhang W, Du S, Zhang X, Guo W, Yin Z. Organ donation decision-making in ICU patients: from the perspectives of organ coordinators and physicians in China - a qualitative study. BMJ Open 2023; 13:e075433. [PMID: 37914298 PMCID: PMC10626822 DOI: 10.1136/bmjopen-2023-075433] [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: 05/08/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVES Intensive care unit (ICU) dying patients are the most important source of organ donation. This study explores the reasons affecting organ donation in the Chinese sociocultural context from the perspectives of coordinators and physicians, and further seeks countermeasures to alleviate the shortage of organs. DESIGN AND SETTING Semistructured interviews conducted in a large tertiary hospital in China. PARTICIPANTS AND METHOD 15 respondents (including 8 organ coordinators and 7 ICU physicians) were interviewed. Participants were invited to describe the factors that influence organ donation and the underlying reasons behind it. Bronfenbrenner's socioecological system model was used as theoretical support to construct a theoretical model of the factors influencing organ donation. Respondents participated in semistructured qualitative interviews that were audio-recorded and transcribed. The relevant data were analysed using thematic analysis. RESULTS Four themes that influenced organ donation were identified including the influence of the deceased person's attributes, immediate family members, surrounding people and the environment, and the social-level factors. In addition, we obtained four strategies from the interviews to improve the organ shortage to ameliorate the current supply-demand imbalance in organ donation. These include multilevel publicity, relevant policy support, increasing other forms of supply and reducing organ demand. CONCLUSIONS Factors affecting organ donation after the death of a Chinese citizen include the personal characteristics of the donor, the decisions of family members such as immediate family members and the indirect influence of surrounding people such as collateral family members, in addition to factors related to the humanistic environment, religious beliefs and social opinion.
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Affiliation(s)
- Xi Yang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - ChaoQun Chen
- Organ Procurement Organizations, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kun Geng
- Organ Procurement Organizations, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuedong Jia
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - FangYing Si
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - XiaoJing Lu
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wan Zhang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuzhang Du
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaojian Zhang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenzhi Guo
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhao Yin
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
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2
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Salter EK, Hester DM, Vinarcsik L, Matheny Antommaria AH, Bester J, Blustein J, Wright Clayton E, Diekema DS, Iltis AS, Kopelman LM, Malone JR, Mercurio MR, Navin MC, Paquette ET, Pope TM, Rhodes R, Ross LF. Pediatric Decision Making: Consensus Recommendations. Pediatrics 2023; 152:e2023061832. [PMID: 37555276 DOI: 10.1542/peds.2023-061832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 08/10/2023] Open
Abstract
Despite apparent disagreement in the scholarly literature on standards of pediatric decision making, a recognition that similar norms underpin many of the dominant frameworks motivated a June 2022 symposium "Best Interests and Beyond: Standards of Decision Making in Pediatrics" in St Louis, MO. Over the course of this 3-day symposium, 17 expert scholars (see author list) deliberated on the question "In the context of US pediatric care, what moral precepts ought to guide parents and clinicians in medical decision making for children?" The symposium and subsequent discussion generated 6 consensus recommendations for pediatric decision making, constructed with the primary goals of accessibility, teachability, and feasibility for practicing clinicians, parents, and legal guardians. In this article, we summarize these recommendations, including their justification, limitations, and remaining concerns.
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Affiliation(s)
| | - D Micah Hester
- University of Arkansas for Medical Sciences, College of Medicine, Department of Medical Humanities & Bioethics, Little Rock, Arkansas
- Arkansas Children's Hospital, Little Rock, Arkansas
| | | | - Armand H Matheny Antommaria
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Ellen Wright Clayton
- Vanderbilt University Medical Center & Vanderbilt University, Nashville, Tennessee
| | | | - Ana S Iltis
- Wake Forest University, Winston-Salem, North Carolina
| | - Loretta M Kopelman
- East Carolina University, Greenville, North Carolina
- Georgetown University, Washington, District of Columbia
| | | | | | - Mark C Navin
- Oakland University, Rochester, Michigan
- Corwell Health East, Southfield, Michigan
| | - Erin Talati Paquette
- Northwestern University, Chicago, Illinois
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | - Lainie F Ross
- University of Chicago, Chicago, Illinois
- University of Rochester, Rochester New York
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3
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Rigaud JP, Ecarnot F, Quenot JP. Patient Information and Consent for Care in the Intensive Care Unit. Healthcare (Basel) 2023; 11:healthcare11050707. [PMID: 36900711 PMCID: PMC10001104 DOI: 10.3390/healthcare11050707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023] Open
Abstract
In this paper, we review the ethical issues involved in providing information to, and obtaining consent (for treatment and/or research) from patients in the intensive care unit. We first review the ethical obligations of the physician in treating patients, who are by definition, vulnerable, and often unable to assert their autonomy during situations of critical illness. Providing clear and transparent information to the patient about treatment options or research opportunities is an ethical and, in some cases, legal obligation for the physicians, but may be rendered difficult, not to say impossible in the intensive care unit by the patient's health state. In this context, we review the specificities of intensive care with respect to information and consent. We discuss who the right contact person is in the ICU setting, with possible choices including a surrogate decision maker, or a member of the family, in the absence of an officially designated surrogate. We further review the specific considerations relating to the family of critically ill patients, and the amount and type of information that may be given to them without breaching the tenets of medical confidentiality. Finally, we discuss the specific cases of consent to research, and patients who refuse care.
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Affiliation(s)
- Jean-Philippe Rigaud
- Department of Intensive Care, Centre Hospitalier, 76202 Dieppe, France
- Espace de Réflexion Éthique de Normandie, University Hospital Caen, 14000 Caen, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besançon, 25000 Besançon, France
- EA3920, University of Franche-Comté, 25000 Besançon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, Burgundy University Hospital, 21079 Dijon, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, 21078 Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, 21078 Dijon, France
- Correspondence:
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4
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Anything Goes? Analyzing Varied Understandings of Assent. Camb Q Healthc Ethics 2023; 32:76-89. [PMID: 36468375 DOI: 10.1017/s0963180122000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Assent to medical research or treatment may be an intuitively attractive way to address the area between incapacity and capacity that might otherwise be subject to a best interests assessment. Assent has become a widely disseminated concept in law, research, and clinical ethics, but little conceptual work on assent has so far occurred. An exploration of use of assent in treatment and research in children and people with dementia suggests that at least five claims are made on behalf of assent. Since at least some of these may lead to tensions with others, assent requires firmer conceptual underpinning. Whether assent remains primarily a local approach to research in children in the United States, where it appears to fit with legal background conditions, or develops its promise to overturn the dominant, binary, approach to (in)capacity will depend on the strength of future philosophical work to improve the theoretical foundations to assent.
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5
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Patra L, Ghoshal A, Damani A, Salins N. Cancer palliative care referral: patients' and family caregivers' perspectives - a systematic review. BMJ Support Palliat Care 2022:spcare-2022-003990. [PMID: 36328397 DOI: 10.1136/spcare-2022-003990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite the evidence of palliative care benefits, referrals are infrequent and delayed. Patients and their caregivers are essential stakeholders in the referral process with valuable perspectives. This review systematically explored their perceived facilitators and barriers to palliative care referral. METHODS 4 subject-specific databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and EMBASE), 3 multidisciplinary databases (SCOPUS, Web of Science and Cochrane database) and 11 journals from 1 January 1990 to 31 May 2022 were searched; and scored for their methodological rigour using Hawker's tool. Findings were synthesised using Popay's Narrative Synthesis method and interpreted using decision-making theory. RESULTS 4 themes were generated from 14 studies: (1) The timing of referral should be right and communication must be comprehensive. Delays in initiating serious illness conversations, prognostication, and decision-making hindered referral. In contrast, the presence of symptoms facilitated it. (2) Referral was equated to death, and as an inferior form of treatment, a rebranding might mitigate the stigma. (3) Referral made families feel emotional and devastated; explanation and team initiatives enabled the normalisation and positive coping. (4) Long-term holistic palliative care facilitated a positive care experience and a sense of reassurance and satisfaction, enabling a smooth transition from curative to comfort care. The late referral was associated with perceived inadequate symptom management, diminished quality of life and death and complicated bereavement issues. CONCLUSION Patients' and caregivers' predisposition to palliative care engagement was influenced by timely referral, comprehensive communication, perception and stigma about palliative care. Longitudinal association with the palliative care team mitigated negative perceptions and improved satisfaction and coping. PROSPERO REGISTRATION NUMBER CRD42018091481.
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Affiliation(s)
- Lipika Patra
- Bagchi-Karunashraya Palliative Care Centre, Bangalore Hospice Trust, Bhubaneswar, India
| | | | - Anuja Damani
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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6
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Gharaibeh L, Al-Azzam SI, Alzoubi KH, Karasneh RA, Abu-Farha R. Knowledge, practices, and patterns of data confidentiality among pharmacists in a developing country. Heliyon 2022; 8:e09115. [PMID: 35342831 PMCID: PMC8941157 DOI: 10.1016/j.heliyon.2022.e09115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/09/2021] [Accepted: 03/11/2022] [Indexed: 02/03/2023] Open
Abstract
Background Increased application of electronic health information systems led to the buildup of patient information and facilitated access to this data. Consequently, the confidentiality of this information became an ethical challenge to medical teams' members including pharmacists. However, no study has been conducted to assess pharmacists' knowledge or practices of data confidentiality. Thus, the aim of this study was to assess the current practices and knowledge of pharmacists concerning data confidentiality. Methods This was a cross sectional study that included clinical pharmacists in tertiary hospitals and health care centers in Jordan. Data was collected through phone or face to face interviews using a data collection sheet. All continuous data was presented as median ± interquartile range (IQR) and categorical data as frequency (%). One way Chi square was used to check significant differences among categorical groups. Predictors that may affect knowledge and behavior scores were screened using simple linear regression. Results A total of 388 pharmacists were interviewed with a mean age of 39.59 ± 8.32 years, with an average experience of 12.55 ± 7.30 years. Pharmacists relied on their personal experience to resolve ethical dilemmas (n = 274, 70.3%), and when they seek advice, their work colleagues (n = 180, 46.4%) %), followed by the head of departments (144 n; 37.1%), were the main source of advice on ethical issues. The overall median knowledge score of pharmacists about data confidentiality was 2.0 out of 5.0 (IQR = 2.0). A considerable percentage of the pharmacists was willing to share information with family members without asking for permission from the patient (n = 98, 25.3%). Pharmacists had a median behavior score of 3.5 out of 4.0 (IQR = 0.4) regarding practices related to data confidentiality, where the majority of them handled medical information from the patient with great confidentiality (304 n, 78.4%), and 85.8% of them (n = 333) gave patient's sexual diseases-related medical information the highest confidentiality. However, based on univariate and multivariate linear regression analysis, none of the examined sociodemographic variables significantly predicted pharmacists' knowledge or behaviors (P > 0.05). Conclusion Pharmacists are aware of the importance of confidentiality issues of their patients. However, a number of gaps in their knowledge and practices of data confidentiality were identified. Training that targets these gaps in their knowledge, and rectifies incorrect practices is needed during university education and as part of their continuous medical education.
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Affiliation(s)
- Lobna Gharaibeh
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 19328, Jordan
| | - Sayer I. Al-Azzam
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Karem H. Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates,Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan,Corresponding author.
| | - Reema A. Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
| | - Rana Abu-Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, PO. 11931 Amman, Jordan
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7
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Johnston C. Good enough? Parental decisions to use DIY looping technology to manage type 1 diabetes in children. Monash Bioeth Rev 2021; 39:26-41. [PMID: 34402035 DOI: 10.1007/s40592-021-00133-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 11/29/2022]
Abstract
People are using innovative internet of things technologies to gain individualised management of their type 1 diabetes. The #WeAreNotWaiting movement supports them to build their own hybrid closed loop systems and access their real time blood sugar data via any web connected device. A small number of parents in Australia use such DIY looping systems to manage their child's type 1 diabetes, but these systems have not been approved by the Therapeutic Goods Administration in Australia, creating ethical dilemmas for clinicians about how to respond to the use of medical devices that are not registered on the Australian Register of Therapeutic Goods. This article considers whether the use of DIY looping is in the best interests of the child and, if not, whether intervention in parental decision making is justified to prevent harm to the child. It addresses the ongoing duty of healthcare professionals to provide care to children who are 'looping.' Reference is made to findings from a study, Personalised Closed Loop Systems for Childhood Diabetes, to illustrate stakeholders' perceptions of benefits and harms of DIY looping systems. I conclude that the decision of parents to use DIY looping technology could be considered to be in a child's best interests, broadly defined, and falls within the Zone of Parental Discretion, however healthcare practitioners who support parents may have professional concerns in doing so.
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Affiliation(s)
- Carolyn Johnston
- University of Tasmania, Hobart, TAS, Australia. .,Melbourne Law School, The University of Melbourne, 185 Pelham Street, Carlton, VIC, 3010, Australia.
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8
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Marrast L, Conigliaro J, Chan C, Kim EJ, Duer-Hefele J, Diefenbach MA, Davidson KW. Racial and ethnic minority patient participation in N-of-1 trials: perspectives of healthcare providers and patients. Per Med 2021; 18:347-359. [PMID: 34047197 DOI: 10.2217/pme-2020-0166] [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] [Indexed: 12/14/2022]
Abstract
Aim: Patients from racial and ethnic minority backgrounds in the USA have historically been under-represented in research trials. Understanding their viewpoints regarding participation in N-of-1 trials is imperative as we design and implement these studies. Materials & methods: We conducted six focus groups of racial and ethnic minority patients (n = 25) and providers (n = 9). We used content analysis to identify themes. Results: Our results noted the importance of considering family members in N-of-1 trial recruitment and participation, patients' desire for education as a design feature, for 'lifestyle' changes as a treatment option and for use of nonevidence-based treatments in the design of future N-of-1 trials. Conclusion: Personalized trials have the potential to change the way we deliver primary care and improve disparities for minorities.
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Affiliation(s)
- Lyndonna Marrast
- Department of Medicine, Division of General Internal Medicine, The Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, USA.,Institute for Health System Science, Center for Health Innovations & Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
| | - Joseph Conigliaro
- Department of Medicine, Division of General Internal Medicine, The Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, USA.,Institute for Health System Science, Center for Health Innovations & Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
| | - Camille Chan
- Institute for Health System Science, Center for Health Innovations & Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
| | - Eun Ji Kim
- Department of Medicine, Division of General Internal Medicine, The Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, USA.,Institute for Health System Science, Center for Health Innovations & Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
| | - Joan Duer-Hefele
- Institute for Health System Science, Center for Personalized Health, Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
| | - Michael A Diefenbach
- Institute for Health System Science, Center for Health Innovations & Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
| | - Karina W Davidson
- Institute for Health System Science, Center for Personalized Health, Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
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9
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Bridging the Gap: A Mixed Methods Study Investigating Caregiver Integration for People with Geriatric Syndrome. Int J Integr Care 2021; 21:14. [PMID: 33776603 PMCID: PMC7977015 DOI: 10.5334/ijic.5577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Transitions of care between acute hospital and community settings are points of vulnerability for people with geriatric syndrome. Routinely including informal caregivers into the transition processes may mitigate risk. Guidance for operational aspects of caregiver inclusion is currently lacking in healthcare policy and fails to address the barriers faced by caregivers and healthcare professionals. Methods A questionnaire and a semi-structured interview were piloted with acute care physiotherapists who facilitate patient discharge into community settings. The questionnaire was analysed using summary statistics and interviews were thematically analysed by researchers, using NVivo 12 software. Results Questionnaire responses indicated mixed satisfaction with current caregiver integration by the multidisciplinary team. Four themes were shaped in the interviews: inconsistent caregiver engagement, individuals working in a system, an outdated model of care, and invisible care gaps. Discussion Feedback loops constructed from participant questionnaires and interview responses informed the identification of barriers and solutions. These are system wide and address automated integration, cultural shift, reimbursement models, and flexible structures to enhance informal caregiver participation. Future research is urgently required to translate, implement, and evaluate enhanced caregiver integration to ensure sustainable, person-centred healthcare delivery.
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10
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Ullrich A, Theochari M, Bergelt C, Marx G, Woellert K, Bokemeyer C, Oechsle K. Ethical challenges in family caregivers of patients with advanced cancer - a qualitative study. BMC Palliat Care 2020; 19:70. [PMID: 32423444 PMCID: PMC7236546 DOI: 10.1186/s12904-020-00573-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 05/07/2020] [Indexed: 11/26/2022] Open
Abstract
Background Caring for patients with advanced or terminal diseases can confront family caregivers (FC) with ethical challenges. The present study aims at tracing paths connected to ethical challenges among FC of advanced cancer patients by exploring morally troubling situations and related burden, as well as strategies to handle the situation and experience of moral distress from the grieving FC’s perspective. Methods Within a qualitative design, interviews with 12 grieving FC were conducted using a semi-structured interview guide. Data were analysed using grounded theory and abductive reasoning. Results Core phenomena identified were two paths connected to ethical challenges among FC. Ethical challenges occurred in the context of difficult decision-making (Path 1) and in the context of lacking decision-making options when no decision was to be made by FC (Path 2). We found each path to be triggered by distinct sets of morally troubling situations that occurred during the patient’s disease trajectory. In the course of difficult decision-making (Path 1), detrimental external factors could add emotional stress, thus making the decision-making process burdensome. FC used various proactive strategies to overcome those detrimental factors and/or to make the decision. Decisions in conflict with FCs' own moral expectations and values led to moral distress, generating painful emotions. When no decision was to be made by FC (Path 2), FC felt powerless and overrun, which was associated with major emotionality in terms of anxiety and confusion. Either detrimental factors aggravated these feelings to paralyzing shock, or internal resources enabled FC to accept the situation. While acceptance prevented moral distress, paralyzing shock often caused a sense of not meeting their their own moral expectations and values, resulting in moral distress. In both paths, factors were identified that helped FC finding closure and prevented moral residue. Nevertheless, some FC experienced residual moral distress months after the morally troubling situation had occurred. Conclusion Findings provide first information towards understanding paths leading to ethical challenges in FC and can help clinicians to minimize associated emotional burden and moral distress.
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Affiliation(s)
- Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Marianna Theochari
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriella Marx
- Department of Palliative Medicine, University Medical Center Goettingen, Goettingen, Germany.,Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Woellert
- Department of History and Ethics of Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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The Role of the Family in Deceased Organ Procurement: A Guide for Clinicians and Policymakers. Transplantation 2019; 103:e112-e118. [PMID: 31033855 DOI: 10.1097/tp.0000000000002622] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Families play an essential role in deceased organ procurement. As the person cannot directly communicate his or her wishes regarding donation, the family is often the only source of information regarding consent or refusal. We provide a systematic description and analysis of the different roles the family can play, and actions the family can take, in the organ procurement process across different jurisdictions and consent systems. First, families can inform or update healthcare professionals about a person's donation wishes. Second, families can authorize organ procurement in the absence of deceased's preferences and the default is not to remove organs, and oppose donation where there is no evidence of preference but the default is to presume consent; in both cases, the decision could be based on their own wishes or what they think the deceased would have wanted. Finally, families can overrule the known wishes of the deceased, which can mean preventing donation, or permitting donation when the deceased refused it. We propose a schema of 4 levels on which to map these possible family roles: no role, witness, surrogate, and full decisional authority. We conclude by mapping different jurisdictions onto this schema to provide a more comprehensive understanding of the consent system for organ donation and some important nuances about the role of families. This classificatory model aims to account for the majority of the world's consent systems. It provides conceptual and methodological guidance that can be useful to researchers, professionals, and policymakers involved in organ procurement.
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12
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Mapes MV, DePergola PA, McGee WT. Patient-Centered Care and Autonomy: Shared Decision-Making in Practice and a Suggestion for Practical Application in the Critically Ill. J Intensive Care Med 2019; 35:1352-1355. [PMID: 31451000 DOI: 10.1177/0885066619870458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Decision-making for the hospitalized dying and critically ill is often characterized by an understanding of autonomy that leads to clinical care and outcomes that are antithetical to patients' preferences around suffering and quality of life. A better understanding of autonomy will facilitate the ultimate goal of a patient-centered approach and ensure compassionate, high-quality care that respects our patients' values. We reviewed the medical literature and our experiences through the ethics service, palliative care service, and critical care service of a large community teaching hospital. The cumulative experience of a senior intensivist was filtered through the lens of a medical ethicist and the palliative care team. The practical application of patient-centered care was discerned from these interactions. We determined that a clearer understanding of patient-centeredness would improve the experience and outcomes of care for our patients as well as our adherence to ethical practice. The practical applications of autonomy and patient-centered care were evaluated by the authors through clinical interactions on the wards to ascertain problems in understanding their meaning. Clarification of autonomy and patient-centeredness is provided using specific examples to enhance understanding and application of these principles in patient-centered care.
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Affiliation(s)
- Marianna V Mapes
- 6637Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Clinical Ethics, Baystate Health, Springfield, MA, USA
| | - Peter A DePergola
- Department of Clinical Ethics, Baystate Health, Springfield, MA, USA
| | - William T McGee
- Critical Care Division, 21645Baystate Medical Center, Springfield, MA, USA
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13
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Ohanian DM, Stiles-Shields C, Afzal KI, Bechtel Driscoll CF, Lennon Papadakis J, Stern A, Starnes M, Holmbeck GN. Cultural Considerations for Autonomy and Medical Adherence in a Young Palestinian American Muslim Female With Spina Bifida: A Longitudinal Case Study in a Research Context. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2018; 6:386-397. [PMID: 31231602 DOI: 10.1037/cpp0000250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This case study examines the unique presentation of a young Palestinian-American Muslim female, who is a part of an ongoing longitudinal study examining family and peer relationships, psychological adjustment, and neuropsychological functioning in youth with spina bifida. Throughout ten years of data collection, Palestinian-Arab culture and Islamic faith have consistently emerged as important factors that can be considered when interpreting this participant's general level of autonomy, medical autonomy, medical adherence, and psychological adjustment. This case study examines important aspects of adaptive and independent functioning for youth with spina bifida and how this family's culture interacts with these different domains of functioning. Moreover, it explores potential conflicts between an Arab collectivist family structure and Western biomedical ethics and suggests how clinicians might navigate these conflicts and bolster culturally-rooted strengths of families and patients from non-Western backgrounds.
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Affiliation(s)
- Diana M Ohanian
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Colleen Stiles-Shields
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Khalid I Afzal
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, 5841 S Maryland Ave, MC 3077, Chicago, IL 60637
| | | | | | - Alexa Stern
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Meredith Starnes
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
| | - Grayson N Holmbeck
- Loyola University Chicago, Psychology Department, 1032 W. Sheridan Road, Chicago, IL 60660
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14
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Al-Bahri A, Al-Moundhri M, Al-Mandhari Z, Al-Azri M. The role of patients’ families in treatment decision-making among adult cancer patients in the Sultanate of Oman. Eur J Cancer Care (Engl) 2018; 27:e12845. [DOI: 10.1111/ecc.12845] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2018] [Indexed: 12/01/2022]
Affiliation(s)
- A. Al-Bahri
- Department of Health Information and Statistics; Ministry of Health; Al-Nahdha Hospital; Muscat Oman
| | - M. Al-Moundhri
- Oncology Unit; Department of Medicine; College of Medicine and Health Sciences; Sultan Qaboos University; Muscat Oman
| | - Z. Al-Mandhari
- The National Oncology Center; The Royal Hospital; Muscat Oman
| | - M. Al-Azri
- Department of Family Medicine and Public Health; College of Medicine and Health Sciences; Sultan Qaboos University; Muscat Oman
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15
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Al-Bahri A, Al-Moundhri M, Al-Azri M. The Role of Patients' Families in Cancer Treatment Decision-Making: Perspectives among Eastern and Western families. Sultan Qaboos Univ Med J 2018; 17:e383-e385. [PMID: 29372077 DOI: 10.18295/squmj.2017.17.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/20/2017] [Accepted: 11/26/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- Abdulrahim Al-Bahri
- Department of Health Information & Statistics, Al Nahdha Hospital, Muscat, Oman
| | - Mansour Al-Moundhri
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al-Azri
- Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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16
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Truth, Progress, and Regress in Bioethics. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2017. [DOI: 10.1093/jmp/jhx027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Wouters RHP, Bijlsma RM, Ausems MGEM, van Delden JJM, Voest EE, Bredenoord AL. Am I My Family's Keeper? Disclosure Dilemmas in Next-Generation Sequencing. Hum Mutat 2017; 37:1257-1262. [PMID: 27647774 DOI: 10.1002/humu.23118] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 09/11/2016] [Accepted: 09/12/2016] [Indexed: 01/18/2023]
Abstract
Ever since genetic testing is possible for specific mutations, ethical debate has sparked on the question of whether professionals have a duty to warn not only patients but also their relatives that might be at risk for hereditary diseases. As next-generation sequencing (NGS) swiftly finds its way into clinical practice, the question who is responsible for conveying unsolicited findings to family members becomes increasingly urgent. Traditionally, there is a strong emphasis on the duties of the professional in this debate. But what is the role of the patient and her family? In this article, we discuss the question of whose duty it is to convey relevant genetic risk information concerning hereditary diseases that can be cured or prevented to the relatives of patients undergoing NGS. We argue in favor of a shared responsibility for professionals and patients and present a strategy that reconciles these roles: a moral accountability nudge. Incorporated into informed consent and counseling services such as letters and online tools, this nudge aims to create awareness on specific patient responsibilities. Commitment of all parties is needed to ensure adequate dissemination of results in the NGS era.
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Affiliation(s)
- Roel H P Wouters
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rhodé M Bijlsma
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Emile E Voest
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annelien L Bredenoord
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
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18
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Alden DL, Friend J, Lee PY, Lee YK, Trevena L, Ng CJ, Kiatpongsan S, Lim Abdullah K, Tanaka M, Limpongsanurak S. Who Decides: Me or We? Family Involvement in Medical Decision Making in Eastern and Western Countries. Med Decis Making 2017; 38:14-25. [DOI: 10.1177/0272989x17715628] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Research suggests that desired family involvement (FI) in medical decision making may depend on cultural values. Unfortunately, the field lacks cross-cultural studies that test this assumption. As a result, providers may be guided by incomplete information or cultural biases rather than patient preferences. Methods. Researchers developed 6 culturally relevant disease scenarios varying from low to high medical seriousness. Quota samples of approximately 290 middle-aged urban residents in Australia, China, Malaysia, India, South Korea, Thailand, and the USA completed an online survey that examined desired levels of FI and identified individual difference predictors in each country. All reliability coefficients were acceptable. Regression models met standard assumptions. Results. The strongest finding across all 7 countries was that those who desired higher self-involvement (SI) in medical decision making also wanted lower FI. On the other hand, respondents who valued relational-interdependence tended to want their families involved – a key finding in 5 of 7 countries. In addition, in 4 of 7 countries, respondents who valued social hierarchy desired higher FI. Other antecedents were less consistent. Conclusion. These results suggest that it is important for health providers to avoid East–West cultural stereotypes. There are meaningful numbers of patients in all 7 countries who want to be individually involved and those individuals tend to prefer lower FI. On the other hand, more interdependent patients are likely to want families involved in many of the countries studied. Thus, individual differences within culture appear to be important in predicting whether a patient desires FI. For this reason, avoiding culture-based assumptions about desired FI during medical decision making is central to providing more effective patient centered care.
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Affiliation(s)
- Dana L. Alden
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - John Friend
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Ping Yein Lee
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Yew Kong Lee
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Lyndal Trevena
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Chirk Jenn Ng
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Sorapop Kiatpongsan
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Khatijah Lim Abdullah
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Miho Tanaka
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Supanida Limpongsanurak
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
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19
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Cherry MJ, Fan R. Informed Consent: The Decisional Standing of Families. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2015; 40:363-70. [DOI: 10.1093/jmp/jhv012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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