1
|
Hatoum WBA, Sperling D. Shared decision-making in end-of-life care for end-stage renal disease patients: nephrologists' views and attitudes. Isr J Health Policy Res 2024; 13:45. [PMID: 39256820 PMCID: PMC11385125 DOI: 10.1186/s13584-024-00632-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/30/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND The term end-stage renal disease (ESRD) refers to the final stage of chronic kidney disease. Not all ESRD patients are suitable for dialysis treatment, which despite its advantages, is not without risks. Shared nephrologist-patient decision-making could be beneficial at this stage, yet little is known about such practices in Israel. This study aimed at examining the practice of shared decision-making (SDM) between nephrologists and ESRD patients in Israel, while exploring related conflicts, ethical dilemmas, and considerations. METHODS The descriptive-quantitative approach applied in this study included a validated questionnaire for nephrologists, based on Emanual and Emanual (1992). The survey, which was distributed via social-media platforms and snowball sampling, was completed by 169 nephrologists. Data analysis included t-tests for independent samples, f-tests for analysis of variance, and t-tests and f-tests for independence. Descriptive analysis examined attitudes towards SDM in end-of-life care for ESRD patients. RESULTS The findings show that the research sample did not include nephrologists who typically act according to the paternalistic decision-making style. Rather, 53% of the respondents were found to act in line with the informative decision-making style, while 47% act according to the interpretive decision-making style. Almost 70% of all respondents reported their discussing quality-of-life with patients; 63.4% provide prognostic assessments; 61.5% inquire about the patient's desired place of death; 58.6% ask about advance directives or power-of-attorney; and 57.4% inquire about cultural and religious beliefs in end-of-life treatment. Additionally, informative nephrologists tend to promote the patients' autonomy over their health (P < 0.001); they are also in favor of conservative treatment, compared to paternalistic and interpretive nephrologists, and use less invasive methods than other nephrologists (P = 0.02). CONCLUSIONS Nephrologists in Israel only partially pursue an SDM model, which has the potential to improve quality-of-care for ESRD patients and their families. SDM programs should be developed and implemented for increasing such practices among nephrologists, thereby expanding the possibilities for providing conservative care at end-of-life.
Collapse
Affiliation(s)
- Wassiem Bassam Abu Hatoum
- Faculty of Social Welfare and Health Sciences, Department of Nursing, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, Israel.
- Department of Nephrology and hypertension, Haemek Medical Center, Afula, Israel, Yitshak Rabin Boulevard , 1834111.
| | - Daniel Sperling
- Faculty of Social Welfare and Health Sciences, Department of Nursing, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, Israel
| |
Collapse
|
2
|
Quek CWN, Ong RRS, Wong RSM, Chan SWK, Chok AKL, Shen GS, Teo AYT, Panda A, Burla N, Wong YA, Chee RCH, Loh CYL, Lee KW, Tan GHN, Leong REJ, Koh NSY, Ong YT, Chin AMC, Chiam M, Lim C, Zhou XJ, Ong SYK, Ong EK, Krishna LKR. Systematic scoping review on moral distress among physicians. BMJ Open 2022; 12:e064029. [PMID: 36691160 PMCID: PMC9442489 DOI: 10.1136/bmjopen-2022-064029] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/15/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Concepts of moral distress (MD) among physicians have evolved and extend beyond the notion of psychological distress caused by being in a situation in which one is constrained from acting on what one knows to be right. With many accounts involving complex personal, professional, legal, ethical and moral issues, we propose a review of current understanding of MD among physicians. METHODS A systematic evidence-based approach guided systematic scoping review is proposed to map the current concepts of MD among physicians published in PubMed, Embase, PsycINFO, Web of Science, SCOPUS, ERIC and Google Scholar databases. Concurrent and independent thematic and direct content analysis (split approach) was conducted on included articles to enhance the reliability and transparency of the process. The themes and categories identified were combined using the jigsaw perspective to create domains that form the framework of the discussion that follows. RESULTS A total of 30 156 abstracts were identified, 2473 full-text articles were reviewed and 128 articles were included. The five domains identified were as follows: (1) current concepts, (2) risk factors, (3) impact, (4) tools and (5) interventions. CONCLUSIONS Initial reviews suggest that MD involves conflicts within a physician's personal beliefs, values and principles (personal constructs) caused by personal, ethical, moral, contextual, professional and sociocultural factors. How these experiences are processed and reflected on and then integrated into the physician's personal constructs impacts their self-concepts of personhood and identity and can result in MD. The ring theory of personhood facilitates an appreciation of how new experiences create dissonance and resonance within personal constructs. These insights allow the forwarding of a new broader concept of MD and a personalised approach to assessing and treating MD. While further studies are required to test these findings, they offer a personalised means of supporting a physician's MD and preventing burn-out.
Collapse
Affiliation(s)
- Chrystie Wan Ning Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ryan Rui Song Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ruth Si Man Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Sarah Wye Kit Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Amanda Kay-Lyn Chok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Grace Shen Shen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Andrea York Tiang Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Aiswarya Panda
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Neha Burla
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yu An Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ryan Choon Hoe Chee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Caitlin Yuen Ling Loh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Kun Woo Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Gabrielle Hui Ning Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ryan Emmanuel Jian Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Natalie Song Yi Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | | | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Singapore
| | - Xuelian Jamie Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Simon Yew Kuang Ong
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
- Centre of Biomedical Ethics, National University of Singapore, Singapore
- The Palliative Care Centre for Excellence in Research and Education, Singapore
| |
Collapse
|
3
|
Muishout G, Topcu N, de la Croix A, Wiegers G, van Laarhoven HW. Turkish imams and their role in decision-making in palliative care: A Directed Content and Narrative analysis. Palliat Med 2022; 36:1006-1017. [PMID: 35848214 PMCID: PMC9174576 DOI: 10.1177/02692163221095200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND Muslims are the largest religious minority in Europe. When confronted with life-threatening illness, they turn to their local imams for religious guidance. AIM To gain knowledge about how imams shape their roles in decision-making in palliative care. DESIGN Direct Content Analysis through a typology of imam roles. To explore motives, this was complemented by Narrative Analysis. SETTING/PARTICIPANTS Ten Turkish imams working in the Netherlands, with experience in guiding congregants in palliative care. RESULTS The roles of Jurist, Exegete, Missionary, Advisor and Ritual Guide were identified. Three narratives emerged: Hope can work miracles, Responsibility needs to be shared, and Mask your grief. Participants urged patients not to consent to withholding or terminating treatment but to search for a cure, since this might be rewarded with miraculous healing. When giving consent seemed unavoidable, the fear of being held responsible by God for wrongful death was often managed by requesting fatwa from committees of religious experts. Relatives were urged to hide their grief from dying patients so they would not lose hope in God. CONCLUSION Imams urge patients' relatives to show faith in God by seeking maximum treatment. This attitude is motivated by the fear that all Muslims involved will be held accountable by God for questioning His omnipotence to heal. Therefore, doctors may be urged to offer treatment that contradicts medical standards for good palliative care. To bridge this gap, tailor-made palliative care should be developed in collaboration with imams. Future research might include imams of other Muslim organizations.
Collapse
Affiliation(s)
- George Muishout
- Department of History, European Studies and Religious Studies, Amsterdam School for Historical Studies, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Anne de la Croix
- Research in Education, Amsterdam UMC, Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gerard Wiegers
- Department of History, European Studies and Religious Studies, Amsterdam School for Historical Studies, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanneke Wm van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Weng XR, Nakdali R, Almoosawi B, Al Saeed M, Maiser S, Al Banna M. Health Care Providers' Attitudes and Beliefs on Providing Palliative Care to Patients in Bahrain: Findings From a Qualitative Study. J Pain Symptom Manage 2021; 62:98-106.e1. [PMID: 33188863 DOI: 10.1016/j.jpainsymman.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/22/2020] [Accepted: 11/05/2020] [Indexed: 11/17/2022]
Abstract
CONTEXT Present studies suggested that cultural and religious factors, as well as law and policy, may have impeded the advancement of palliative care in the Middle East. Little is known about health care providers' perceptions of palliative care and the barriers to its development in the Gulf Cooperation Council. OBJECTIVES To understand health care professionals' attitudes and beliefs regarding palliative care and highlight current practice barriers in Bahrain. METHODS Semistructured interviews with 16 health care providers (physicians and nurses) were conducted. Thematic analysis was then performed after interviews were transcribed verbatim. RESULTS Health care professionals perceived palliative care as a service only delivered to patients at the end of life. Palliative care was only offered to patients who have been diagnosed with cancer and had exhausted all curative treatments. Do-not-resuscitate orders and code status discussions are not currently practiced. Palliative care decisions are usually decided by patients' families. Middle Eastern culture, health care law and policy, conservative interpretations of Islam, and a lack of professional expertise were identified as barriers. CONCLUSION This study unveiled the perceptions of palliative care among health care professionals in a Gulf Cooperation Council country. Six major barriers that hindered palliative care practice were identified. Future health care policy in the region needs to address these barriers within the current health care system while taking culture, religion, and social factors into consideration.
Collapse
Affiliation(s)
- Xingran R Weng
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Rama Nakdali
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
| | - Barrak Almoosawi
- Department of Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | | | - Samuel Maiser
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mona Al Banna
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA.
| |
Collapse
|