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van Schaik M, Kröger C, Zuidema L, Stolper M, Widdershoven G, Pasman HR, Metselaar S. Training nurses to facilitate and implement CURA in palliative care institutions: development and evaluation of a blended learning program. BMC Palliat Care 2023; 22:158. [PMID: 37865740 PMCID: PMC10590004 DOI: 10.1186/s12904-023-01284-4] [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: 05/22/2023] [Accepted: 10/13/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Healthcare professionals in palliative care are found to be confronted with moral challenges on a frequent basis. CURA is a low-threshold instrument for dialogical ethical reflection that was developed to deal with these challenges. A previous study identified the need of healthcare professionals to be trained to introduce CURA in their organization, initiate and facilitate reflections with CURA, and contribute to the implementation of CURA. The aim of this study was to develop and evaluate a training for professionals to become 'CURA-ambassadors'. METHODS The training was developed in a participatory way in two cycles. We trained 72 healthcare professionals. The training was evaluated by means of a questionnaire and six semi-structured interviews. RESULTS The study resulted in a blended learning training combining training sessions with an e-module and with practicing with organizing and facilitating CURA in daily healthcare practice. The main objectives of the training are to enable CURA-ambassadors to introduce CURA within their organization, initiate and facilitate ethical reflections using CURA, and contribute to the implementation of CURA. Participants were generally positive about the training program and the trainers. Technical difficulties related to the e-module were mentioned as main point of improvement. DISCUSSION The training program can generate ownership, responsibility, and competency among CURA-ambassadors, which are essential foundations for implementing complex interventions in healthcare practice. The training program received positive evaluations shortly after completing the program. This study adds to our understanding of what is needed for healthcare professionals to use CURA, in order to support them in dealing with moral challenges and to foster their moral resilience. Further research is needed to assess whether participants experience the training as sufficient and effective when using and implementing CURA structurally in their organizations over a longer period of time.
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Affiliation(s)
- Malene van Schaik
- Department of Ethics, Law and Humanities, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands.
| | - Charlotte Kröger
- Department of Ethics, Law and Humanities, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Lisa Zuidema
- Department of Ethics, Law and Humanities, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Margreet Stolper
- Department of Ethics, Law and Humanities, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Guy Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - H Roeline Pasman
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Suzanne Metselaar
- Department of Ethics, Law and Humanities, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
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Ethik-Fortbildungen als Element der Klinischen Ethikarbeit: Ein Überblick über Formate und weitere strukturierende Elemente. Ethik Med 2023. [DOI: 10.1007/s00481-023-00755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
ZusammenfassungAusgehend von den Erfahrungswerten sechs Klinischer Ethiker*innen an Universitätsklinika in Deutschland wurde eine strukturierte Auseinandersetzung mit dem Arbeitsfeld der Fortbildungen im Rahmen der Klinischen Ethikarbeit vorgenommen. Die Zusammenarbeit wurde von der Fragestellung geleitet, was bei der Konzeption einer Ethik-Fortbildung innerhalb einer Einrichtung zu berücksichtigen ist. Der methodische Zugang zur Beantwortung der explorativen Fragestellung bestand in einem mehrstufigen, deskriptiven Verfahren, das alternierend in gemeinsamen Arbeitssitzungen und individueller Arbeit zwischen den Sitzungen umgesetzt wurde.Als Resultat zeigt der Aufsatz eine Übersicht über die Bandbreite möglicher Fortbildungsformate auf, die denjenigen Hilfestellung bieten kann, die in ihrer Einrichtung Fortbildungen zu ethischen Themen konzipieren und durchführen wollen. Darüber hinaus bietet er einen Überblick über die bei der Umsetzung jeweils zu berücksichtigenden direkt strukturierenden sowie indirekt strukturierenden Merkmale. Es wird an Beispielen aufgezeigt, welche Formatvarianten sich in Kombination mit welchen direkt strukturierenden Merkmalen in den ausgewählten Universitätsklinika bewährt haben.Der Beitrag liefert eine Diskussionsgrundlage, um die strukturierte Auseinandersetzung mit konzeptionellen Fragen ethischer Fortbildung in der Klinik zu befördern.
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De Panfilis L, Magelssen M, Costantini M, Ghirotto L, Artioli G, Turola E, Perin M. Research, education, ethics consultation: evaluating a Bioethics Unit in an Oncological Research Hospital. BMC Med Ethics 2022; 23:133. [PMID: 36494709 PMCID: PMC9733101 DOI: 10.1186/s12910-022-00863-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aims to quantitatively and qualitatively evaluate the activities of a Bioethics Unit (BU) 5 years since its implementation (2016-2020). The BU is a research unit providing empirical research on ethical issues related to clinical practice, clinical ethics consultation, and ethical education for health care professionals (HPS). METHODS We performed an explanatory, sequential, mixed-method, observational study, using the subsequent qualitative data to explain the initial quantitative findings. Quantitative data were collected from an internal database and analyzed by descriptive analysis. Qualitative evaluation was performed by semi-structured interviews with 18 HPs who were differently involved in the BU's activities and analyzed by framework analysis. RESULTS Quantitative results showed an extensive increment of the number of BU research projects over the years and the number of work collaborations with other units and wards. Qualitative findings revealed four main themes, concerning: 1. the reasons for contacting the BU and the type of collaboration; 2. the role of the bioethicist; 3. the impact of BU activities on HPs, in terms of developing deeper and more mature thinking; 4. the need to extend ethics support to other settings. Overall, our results showed that performing both empirical bioethics research and more traditional clinical ethics activities at the same unit would produce an impetus to increase collaboration and spread an 'ethical culture' among local HPs. CONCLUSIONS Our findings contribute to a growing body of literature on the models of clinical ethics support services and the role of empirical research in bioethics internationally. They also prepare the ground for the implementation of a multidisciplinary Clinical Ethics Committee (CEC) that aims to support the BU's ethics consultation service within the local context.
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Affiliation(s)
| | - Morten Magelssen
- grid.5510.10000 0004 1936 8921Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Massimo Costantini
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanna Artioli
- grid.10383.390000 0004 1758 0937Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Turola
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marta Perin
- Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy ,grid.7548.e0000000121697570PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Alquati S, Peruselli C, Turrà C, Tanzi S. Lesson Learned From Hospital Palliative Care Service in a Cancer Research Center in Italy: Results of 5 Years of Experience. Front Oncol 2022; 12:936795. [PMID: 35832554 PMCID: PMC9271826 DOI: 10.3389/fonc.2022.936795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundInternational studies have documented that over a third of all hospital beds are occupied by patients with palliative care needs in their last year of life. Experiences of Palliative Care Services that take place prevalently or exclusively in hospital settings are very few in Italy.ObjectiveDescribe clinical, educational and research activities performed by a hospital PCS and discussing opportunities and critical issues encountered in an Italian Cancer Center.MethodRetrospective data regarding adults with advanced stage diseases referred from January 2015 to December 2019.ResultsClinical activity - The PCS performed 2422 initial consultations with an average of 484 initial consultations per year. A majority of patients had advanced cancer, from 85% to 72%, with an average of 2583 total consultations per year and an average of 4.63 consultations per patient. The penetrance has increased over time from 6.3% to 15.75%. Educational and research activity - Since 2015, PCS has provided training to health professionals (HPs) of different departments of our hospital. Most of the educational projects for HPs were part of research projects, for example the communication training program, management of pain and end-of-life symptoms and the training program for PC-based skills.ConclusionOur data suggests that a PCS able to provide palliative care to inpatients and outpatient and continuous training support to other hospital specialists can relatively quickly improve the level of its penetrance in hospital activities.
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Affiliation(s)
- Sara Alquati
- Palliative Care Unit, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
- *Correspondence: Sara Alquati, ; orcid.org/0000-0001-8696-9602
| | | | - Caterina Turrà
- Department of Hospital Pharmacy, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Buonaccorso L, Tanzi S, Sacchi S, Alquati S, Bertocchi E, Autelitano C, Taberna E, Martucci G. Self-Care as a Method to Cope With Suffering and Death: A Participatory Action-Research Aimed at Quality Improvement. Front Psychol 2022; 13:769702. [PMID: 35264999 PMCID: PMC8900725 DOI: 10.3389/fpsyg.2022.769702] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/14/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Palliative care is an emotionally and spiritually high-demanding setting of care. The literature reports on the main issues in order to implement self-care, but there are no models for the organization of the training course. We described the structure of training on self-care and its effects for a Hospital Palliative Care Unit. Method We used action-research training experience based mostly on qualitative data. Thematic analysis of data on open-ended questions, researcher’s field notes, oral and written feedback from the trainer and the participants on training outcomes and satisfaction questionnaires were used. Results Four major themes emerged: (1) “Professional role and personal feelings”; (2) “Inside and outside the team”; (3) “Do I listen to my emotions in the care relationship?”; (4) “Death: theirs vs. mine.” According to participants’ point of view and researchers’ observations, the training course resulted in ameliorative adjustments of the program; improved skills in self-awareness of own’s emotions and sharing of perceived emotional burden; practicing “compassionate presence” with patients; shared language to address previously uncharted aspects of coping; allowing for continuity of the skills learned; translation of the language learned into daily clinical practices through specific facilitation; a structured staff’s support system for emotional experiences. Discussion Self-care is an important enabler for the care of others. The core of our intervention was to encourage a meta-perspective in which the trainees developed greater perspicacity pertaining to their professional role in the working alliance and also recognizing the contribution of their personal emotions to impasse experienced with patients.
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Affiliation(s)
- Loredana Buonaccorso
- Psycho-Oncology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simona Sacchi
- Palliative Care Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Alquati
- Palliative Care Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Bertocchi
- Palliative Care Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cristina Autelitano
- Palliative Care Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Eleonora Taberna
- Azienda Sanitaria dell'Alto Adige, Comprensorio Sanitario di Merano, Merano, Italy
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Hahne J, Wang X, Liu R, Zhong Y, Chen X, Liu X, Khoshnood K, Li X. Chinese physicians' perceptions of palliative care integration for advanced cancer patients: a qualitative analysis at a tertiary hospital in Changsha, China. BMC Med Ethics 2022; 23:17. [PMID: 35246107 PMCID: PMC8895637 DOI: 10.1186/s12910-022-00750-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/01/2022] [Indexed: 12/30/2022] Open
Abstract
Background Little previous research has been conducted outside of major cities in China to examine how physicians currently perceive palliative care, and to identify specific goals for training as palliative care access expands. This study explored physicians’ perceptions of palliative care integration for advanced cancer patients in Changsha, China. Methods We conducted semi-structured qualitative interviews with physicians (n = 24) specializing in hematology or oncology at a tertiary hospital. Results Most physicians viewed palliative care as equivalent to end-of-life care, while a minority considered it possible to integrate palliative care with active treatment. Almost all physicians maintained separate conversations about palliative care with family members and patients, communicating more directly with family members than with patients about prognosis and goals of care. Physicians described experiencing ethical tension between the desire of family members to protect the patient from knowing they have advanced cancer, and the patient’s “right to decide” about palliative treatment. Physicians varied overall regarding perceptions of the role they should have in discussions about goals of care. Conclusions As palliative care access expands in China, medical training should encourage earlier integration of palliative care for advanced cancer, address ethical issues faced by physicians communicating about palliative care, and establish guidance on the role of the physician in discussions about goals of care.
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Affiliation(s)
| | - Xiaomin Wang
- Center of Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, 410013, People's Republic of China.,Center for Medical Ethics, Central South University, Changsha, 410013, People's Republic of China
| | - Rui Liu
- Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha, 410013, People's Republic of China
| | - Yuqiong Zhong
- School of Public Administration, Central South University, Changsha, 410075, People's Republic of China
| | - Xin Chen
- Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha, 410013, People's Republic of China
| | - Xing Liu
- Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | | | - Xin Li
- Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha, 410013, People's Republic of China.
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Giordano A, De Panfilis L, Perin M, Servidio L, Cascioli M, Grasso MG, Lugaresi A, Pucci E, Veronese S, Solari A. Advance Care Planning in Neurodegenerative Disorders: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020803. [PMID: 35055625 PMCID: PMC8775509 DOI: 10.3390/ijerph19020803] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 01/27/2023]
Abstract
Advance care planning (ACP) is increasingly acknowledged as a key step to enable patients to define their goals/preferences for future medical care, together with their carers and health professionals. We aimed to map the evidence on ACP in neurodegenerative disorders. We conducted a scoping review by searching PubMed (inception-December 28, 2020) in addition to trial, review, and dissertation registers. From 9367 records, we included 53 studies, mostly conducted in Europe (45%) and US-Canada (41%), within the last five years. Twenty-six percent of studies were qualitative, followed by observational (21%), reviews (19%), randomized controlled trials (RCTs, 19%), quasi-experimental (11%), and mixed-methods (4%). Two-thirds of studies addressed dementia, followed by amyotrophic lateral sclerosis (13%), and brain tumors (9%). The RCT interventions (all in dementia) consisted of educational programs, facilitated discussions, or videos for patients and/or carers. In conclusion, more research is needed to investigate barriers and facilitators of ACP uptake, as well as to develop/test interventions in almost all the neurodegenerative disorders. A common set of outcome measures targeting each discrete ACP behavior, and validated across the different diseases and cultures is also needed.
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Affiliation(s)
- Andrea Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (A.G.); (L.S.)
| | - Ludovica De Panfilis
- Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (L.D.P.); (M.P.)
| | - Marta Perin
- Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (L.D.P.); (M.P.)
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Laura Servidio
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (A.G.); (L.S.)
| | - Marta Cascioli
- Hospice ‘La Torre sul Colle’, Azienda USL Umbria 2, 06049 Spoleto, Italy;
| | | | - Alessandra Lugaresi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, 40126 Bologna, Italy;
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Eugenio Pucci
- UOC Neurologia, ASUR Marche-AV4, 63900 Fermo, Italy;
| | | | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (A.G.); (L.S.)
- Correspondence: ; Tel.: +39-022344660
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Sarli L, Artioli G, Bogotto S, Labelli E, Pittella F, Guasconi M, De Simone R, De Luca E, Rossi S, D’Apice C. From classroom training to e-learning: a journey through the quality of learning life of nurse students in post-graduate education - A longitudinal qualitative study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022192. [PMID: 35545973 PMCID: PMC9534212 DOI: 10.23750/abm.v93is2.13080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 11/05/2022]
Abstract
Background and aim: recent studies regarding COVID-19 experiences of nursing students highlighted the effect of the transition from face-to-face to online education, rather than the complexity of the overall quality of educational life. This study aim investigating of how the students perceive the quality of educational life in the forced online training, searching for any shift of meanings concerning the students learning experience, from the first phase of the sudden transition to online and the online stabilization phase. Methods: a longitudinal qualitative study, carried during two moments of the online teaching activity forced by COVID-19, the first one in May-June 2020 and the second six months later in January -February 2021. A convenience sample of 24 students attending post-graduate courses for health professions recruited at University of Parma, answered in-depth interviews, videotaped, verbatim transcribed and analyzed using the Braun and Clarke model. Results: five themes emerged from meaning shift of data collection: reactions to change in educational life; factors hindering the perception of the quality of educational life; strategies to facilitate communication and lack of the classroom; factors favoring a new quality of educational life; adaptation strategies to the new educational life. Conclusions: participants perceive advantages of online teaching, on quality of their educational life. The issue of how to create opportunities for internship period remains open. Further research to understand online internship and exploring what extent it is essential to propose it in face-to-face modality. (www.actabiomedica.it)
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Affiliation(s)
- Leopoldo Sarli
- University of Parma, Department of Medicine and Surgery, Parma, Italy
| | - Giovanna Artioli
- University of Parma, Department of Medicine and Surgery, Parma, Italy
| | - Sonia Bogotto
- University of Verona, Department of Medicine and Surgery, Legnago (VR), Italy, “AULSS Scaligera” (Local Health Service),Verona, Italy
| | - Elsa Labelli
- University of Padova, Department of Medicine, Portogruaro (VE), Italy, “AULSS Veneto Orientale” (Local Health Service), San Donà di Piave (VE), Italy
| | - Francesco Pittella
- “IRCCSPoliclinico San Donato” (Local Health Service), Health Professions Research and Development Unit,San Donato Milanese (MI), Italy
| | - Massimo Guasconi
- University of Parma, Department of Medicine and Surgery, Parma, Italy, “Azienda Unità Sanitaria Locale” (Local Health Service) di Piacenza, Piacenza, Italy
| | | | - Enrico De Luca
- University of Parma, Department of Medicine and Surgery, Parma, Italy
| | - Sandra Rossi
- University of Parma, Department of Medicine and Surgery, Parma, Italy
| | - Clelia D’Apice
- University of Parma, Department of Medicine and Surgery, Parma, Italy
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De Panfilis L, Peruselli C, Artioli G, Perin M, Bruera E, Brazil K, Tanzi S. A Qualitative Study on Nudging and Palliative Care: "An Attractive but Misleading Concept". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189575. [PMID: 34574501 PMCID: PMC8468152 DOI: 10.3390/ijerph18189575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 12/04/2022]
Abstract
The debate about the ethical decision-making process in the healthcare context has been enriched with a theory called “nudging”, which has been defined as the framing of information that can significantly influence behaviour without restricting choice. The literature shows very limited data on the opinion and experience of palliative care healthcare professionals on the use of nudging techniques in their care setting. The aim of this study is to explore the beliefs of experienced palliative care professionals towards nudging. We performed a qualitative study using textual data collected through a focus group. It was audio-recorded, and the transcripts were subjected to a thematic analysis. It was performed within an oncological research hospital with a small and multidisciplinary group of healthcare professionals specialised in PC. Participants reported two overarching positions grounded in two main themes: (1) translating nudging in the PC setting and (2) towards a neutral space. The participants found few justifications for the use of nudging in the PC field, even if it can be very attractive and reassuring. Participants also expressed concerns about the excessive risk of developing pure paternalism.
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Affiliation(s)
- Ludovica De Panfilis
- Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
- Correspondence: ; Tel.: +39-0522-269212
| | - Carlo Peruselli
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (C.P.); (G.A.); (S.T.)
| | - Giovanna Artioli
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (C.P.); (G.A.); (S.T.)
| | - Marta Perin
- Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, & Integrative Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK;
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (C.P.); (G.A.); (S.T.)
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De Panfilis L, Peruselli C, Tanzi S, Botrugno C. AI-based clinical decision-making systems in palliative medicine: ethical challenges. BMJ Support Palliat Care 2021; 13:183-189. [PMID: 34257065 DOI: 10.1136/bmjspcare-2021-002948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/28/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Improving palliative care (PC) is demanding due to the increase in people with PC needs over the next few years. An early identification of PC needs is fundamental in the care approach: it provides effective patient-centred care and could improve outcomes such as patient quality of life, reduction of the overall length of hospitalisation, survival rate prolongation, the satisfaction of both the patients and caregivers and cost-effectiveness. METHODS We reviewed literature with the objective of identifying and discussing the most important ethical challenges related to the implementation of AI-based data processing services in PC and advance care planning. RESULTS AI-based mortality predictions can signal the need for patients to obtain access to personalised communication or palliative care consultation, but they should not be used as a unique parameter to activate early PC and initiate an ACP. A number of factors must be included in the ethical decision-making process related to initiation of ACP conversations, among which are autonomy and quality of life, the risk of worsening healthcare status, the commitment by caregivers, the patients' psychosocial and spiritual distress and their wishes to initiate EOL discussions CONCLUSIONS: Despite the integration of artificial intelligence (AI)-based services into routine healthcare practice could have a positive effect of promoting early activation of ACP by means of a timely identification of PC needs, from an ethical point of view, the provision of these automated techniques raises a number of critical issues that deserve further exploration.
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Affiliation(s)
- Ludovica De Panfilis
- Bioethics Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Carlo Peruselli
- Palliative Care Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Carlo Botrugno
- Research Unit on Everyday Bioethics and Ethics of Science, Department of Legal Sciences, University of Florence, Firenze, Toscana, Italy
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Althobaiti MH, Alkhaldi LH, Alotaibi WD, Alshreef MN, Alkhaldi AH, Alshreef NF, Alzahrani NN, Atalla AA. Knowledge, attitude, and practice of medical ethics among health practitioners in Taif government, KSA. J Family Med Prim Care 2021; 10:1759-1765. [PMID: 34123925 PMCID: PMC8144760 DOI: 10.4103/jfmpc.jfmpc_2212_20] [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: 10/27/2020] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: Medical ethics practice and the attitude and knowledge toward it was our concern and aim to investigate. Methods: A cross-sectional study was conducted on 1943 healthcare practitioners from three tertiary care hospitals. A questionnaire requesting demographic data and items related to the level of knowledge and awareness beside the real-life practice of medical ethics among healthcare providers was used. A score was given for each response and a total score was calculated. Results: Of the participants, 86.9% had studied medical ethics, 70.3% thought patients should know about their rights, 87.4% supported that the patient have the right to know and be informed if any malpractice happened, 61.8% never engaged in healthcare-related act on a patient without informed consent, 73% ensured that no one was present other than medical team during assessments or procedures, and 86.6% tried to give only what was necessary to the patient regarding their situation. Nursing specialists/technicians, with of 20-<30 years of practice and participants who had previous training in bioethics had significantly higher mean attitude scores than others. Females, laboratory specialists/technicians, and those who reported previous study of medical ethics had a significantly higher practice scores. A cogent positive correlation was found between the practice and attitude scores. Conclusion: Interduce medical ethics and insist on its importance in medical institutions will positively affect practitioners' knowledge, attitude, and practice.
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Affiliation(s)
| | - Lama H Alkhaldi
- College of Medicine, Taif University, Taif, Kingdom of Saudi Arabia
| | - Waad D Alotaibi
- College of Medicine, Taif University, Taif, Kingdom of Saudi Arabia
| | - Maha N Alshreef
- College of Medicine, Taif University, Taif, Kingdom of Saudi Arabia
| | | | | | | | - Ayman A Atalla
- College of Medicine, Taif University, Taif, Kingdom of Saudi Arabia
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