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Cruse D, Ragazinskaite K, Chinner A, Bareham C, Roberts N, Banner R, Chennu S, Villa D. Family caregivers' sense-making of the results of functional neurodiagnostics for patients with Prolonged Disorders of Consciousness. Neuropsychol Rehabil 2024:1-22. [PMID: 38230516 DOI: 10.1080/09602011.2023.2299448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/06/2023] [Indexed: 01/18/2024]
Abstract
Functional neuroimaging and electrophysiological assessments can identify evidence of residual consciousness and cognition in patients with prolonged disorders of consciousness (PDOC) who are otherwise behaviourally unresponsive. These functional neurodiagnostics are increasingly available in clinical settings and are recommended by international clinical guidelines to reduce diagnostic and prognostic uncertainty, and thereby assist family caregivers in their best-interests decision-making. Nevertheless, little is known about how family caregivers make sense of the results of these state-of-the-art functional neurodiagnostics. By applying Interpretative Phenomenological Analysis (IPA) to interviews with family caregivers of patients with diagnoses of PDOC who had received a functional neurodiagnostic assessment, we identify three primary themes of sense-making: The special significance of "brain scans"; A dynamic sense-making process; Holding on to hope and holding on to the person. These themes highlight the challenges of helping family caregivers to balance the relative importance of functional neurodiagnostic results with other clinical assessments and identify an ability of family caregivers to hold a contradiction in which they hope for recovery but simultaneously express a rational understanding of evidence to the contrary. We offer several recommendations for the ways in which family caregivers can be better supported to make sense of the results of functional neurodiagnostics.
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Affiliation(s)
- Damian Cruse
- Centre for Human Brain Health, University of Birmingham, Edgbaston, UK
- School of Psychology, University of Birmingham, Edgbaston, UK
| | | | - Amy Chinner
- School of Psychology, University of Birmingham, Edgbaston, UK
| | | | - Neil Roberts
- Sawbridgeworth Medical Services, Jacobs & Gardens Neuro Centres, Sawbridgeworth, UK
| | - Ruth Banner
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Srivas Chennu
- School of Computing, University of Kent, Canterbury, UK
| | - Darrelle Villa
- School of Psychology, University of Birmingham, Edgbaston, UK
- Centre for Applied Psychology, University of Birmingham, Edgbaston, UK
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2
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Choi WJ, Young MJ. Disambiguating Consciousness in Clinical Settings. Neurology 2023; 101:896-900. [PMID: 37748883 PMCID: PMC10662996 DOI: 10.1212/wnl.0000000000207765] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/26/2023] [Indexed: 09/27/2023] Open
Affiliation(s)
- William J Choi
- From the Warren Alpert Medical School (W.J.C.), Brown University, Providence, RI; and Department of Neurology (M.J.Y.), Massachusetts General Hospital, Boston.
| | - Michael J Young
- From the Warren Alpert Medical School (W.J.C.), Brown University, Providence, RI; and Department of Neurology (M.J.Y.), Massachusetts General Hospital, Boston
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3
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Samuel G, Sims JM. Drivers and constraints to environmental sustainability in UK-based biobanking: balancing resource efficiency and future value. BMC Med Ethics 2023; 24:36. [PMID: 37264320 DOI: 10.1186/s12910-023-00908-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/20/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Biobanks are a key aspect of healthcare research; they enable access to a wide range of heterogenous samples and data, as well as saving individual researchers time and funds on the collection, storage and/or curation of such resources. However, biobanks are also associated with impacts associated with a depletion of natural resources (energy, water etc.) production of toxic chemicals during manufacturing of laboratory equipment, and effects on biodiversity. We wanted to better understand the biobanking sector in the UK as a first step to assessing the environmental impacts of UK biobanking. METHODS We explored the sample storage infrastructure and environmental sustainability practices at a number of UK biobanks through a mixed methods quantitative and qualitative approach, including information gathering on an online platform, and eight in-depth interviews. RESULTS Environmental sustainability was deprioritised behind biobanks' financial sustainability practices. Nevertheless, both often aligned in practice. However, there was a tendency towards underutilisation of stored samples, the avoidance of centralisation, and providing accessibility to biosamples, and this conflicted with valuing sustainability goals. This related to notions of individualised and competitive biobanking culture. Furthermore, the study raised how value attachments to biosamples overshadows needs for both financial and environmental sustainability concerns. CONCLUSIONS We need to move away from individualised and competitive biobanking cultures towards a realisation that the health of the publics and patients should be first and foremost. We need to ensure the use of biosamples, ahead of their storage ('smart attachments'), align with environmental sustainability goals and participants' donation wishes for biosample use.
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Affiliation(s)
- Gabrielle Samuel
- Department of Global Health and Social Medicine, King's College London, London, UK.
| | - Jessica M Sims
- Division of Surgery and Interventional Science, University College London, London, UK
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Blond N, Andersen LM, Wæhrens EE, Høybye MT. Perspectives on consciousness in patients with disorders of consciousness from brain injury: group concept mapping study across clinic, research, and families. BMC Health Serv Res 2023; 23:471. [PMID: 37165429 PMCID: PMC10173477 DOI: 10.1186/s12913-023-09438-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND An effective healthcare system depends on clinic, research, and patient/relatives interactions. Such interactions may at their core be challenged by misalignments of concepts and the practices that constitute them. The concept of consciousness and what is experienced and understood as signs of consciousness in patients with severe acquired brain injury is one of these potential areas of misalignment. Different perspectives and experiences of consciousness are challenging the delivery of care and the high-stake decision-making process on the potential withdrawal of treatment. The enhanced uncertainties call for reflections on how key stakeholders perceive and identify consciousness in current clinical encounters and practice. METHODS The study empirically explores the actual experiences and conceptions of consciousness concerning patients with disorders of consciousness (DoC) from the perspectives of researchers, health professionals, and relatives of patients, to understand the challenges of the diversity of understandings of consciousness. Engaging the stakeholders by employing Group Concept Mapping methodology, the study developed a situated conceptual map, which reflects nuances and the importance of perspectives on and signs of consciousness. RESULTS Twenty-seven participants contributed to the generation of ideas, 14 took part in the structuring of statements and 10 took part in the validation meeting to interpret the cluster rating map. A total of 85 unique statements were identified and organized into six clusters: (1) Presence, (2) Intentional Activity, (3) Experience of self, (4) Participation in Social Interaction, (5) (Repeated) Response, and (6) Unspecific Reaction. The conceptual mapping demonstrates an extensive overlap in perspectives on consciousness among participants, prioritizing signs that are observable at the bedside. CONCLUSIONS The study provides a first step toward a future framework for the difficult process of decision-making concerning a segment of patients with DoC. The study highlights the importance of repeatable signs of consciousness observed at the bedside and the patient's ability to participate in social interactions, while also considering the importance of non-clinically observable signs of consciousness.
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Affiliation(s)
- Niklas Blond
- Interacting Minds Centre, Department of Clinical Medicine, Aarhus University, Jens Chr. Skous Vej 4, Aarhus C, DK- 8000, Denmark
| | - Lise Marie Andersen
- Center for Elective Surgery, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Eva Elisabeth Wæhrens
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Occupational Science, Department of Public Health, User Perspectives and Community-based Interventions, University of Southern Denmark, Odense, Denmark
| | - Mette Terp Høybye
- Interacting Minds Centre, Department of Clinical Medicine, Aarhus University, Jens Chr. Skous Vej 4, Aarhus C, DK- 8000, Denmark.
- Center for Elective Surgery, Silkeborg Regional Hospital, Silkeborg, Denmark.
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Atherley A, Hu WCY, Dolmans D, Teunissen PW, Hegazi I. Medical Students' Socialization Tactics When Entering a New Clinical Clerkship: A Mixed Methods Study of Proactivity. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:884-893. [PMID: 35171118 PMCID: PMC9126257 DOI: 10.1097/acm.0000000000004627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Socialization into clinical clerkships is difficult in part due to ambiguity around students' new roles and expected behaviors. Being proactive reduces ambiguity and is essential to socialization. Proactive behavior can be taught and goes beyond having a proactive personality. Among students entering new undergraduate clinical clerkships, this study aimed to investigate (1) reported proactive behaviors and their association with social integration and (2) enabling and inhibiting factors for proactive behavior. METHOD This study was conducted at the 5-year MBBS program at Western Sydney University during academic year 2019-2020. Using a convergent mixed methods approach, survey and interview data from third-, fourth-, and fifth-year students were collected. Surveys explored 5 proactive behaviors: feedback seeking, information seeking, task negotiation, positive framing, and relationship building. Interviews elicited descriptions of how students described their proactivity and what influenced students to be proactive when entering a new clerkship. Data were integrated using the following the thread and mixed methods matrix techniques. RESULTS Students exhibited all 5 proactive behaviors. Survey data showed positive framing and task negotiation had the highest and lowest scores, respectively. Only positive framing correlated significantly with social integration scores (r = 0.27; P < .01), but this contrasted to interviews, in which students described how other proactive behaviors also led to social integration. Proactive behavior scores decreased across academic years. Integrated data showed 3 linked antecedents to whether students exhibited proactive behavior: feeling capable of being proactive, individual intention to be proactive, and the immediate environment and system-level factors. CONCLUSIONS Students who framed the experience positively were more likely to report increased social integration. Initiating task negotiation was challenging for most students. The authors propose a conceptual model for proactivity and social integration to support socialization and learning during clinical transitions for future research and interventional design.
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Affiliation(s)
- Anique Atherley
- A. Atherley was a dual PhD candidate, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia, and the School of Health Professions Education, Maastricht University, Maastricht, the Netherlands, at the time of writing. She is now assistant professor, Academy for Teaching and Learning, Ross University School of Medicine, Bridgetown, Barbados; ORCID: https://orcid.org/0000-0002-6350-7285
| | - Wendy C.-Y. Hu
- W.C.-Y. Hu is professor of medical education and associate dean of learning and innovation, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia; ORCID: http://orcid.org/0000-0002-1711-3808
| | - Diana Dolmans
- D. Dolmans is professor of innovative learning arrangements and educational scientist, School of Health Professions Education and the Department of Educational Development & Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0002-4802-1156
| | - Pim W. Teunissen
- P.W. Teunissen is professor of workplace learning in health care, School of Health Professions Education, and gynecologist, Department of Obstetrics & Gynecology, Maastricht University and Maastricht University Medical Center, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0002-0930-0048
| | - Iman Hegazi
- I. Hegazi is director of medical education and the undergraduate academic program, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia; ORCID: https://orcid.org/0000-0002-5428-6564
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Bruni T, Graham M, Norton L, Gofton T, Owen AM, Weijer C. Informed consent for functional MRI research on comatose patients following severe brain injury: balancing the social benefits of research against patient autonomy. JOURNAL OF MEDICAL ETHICS 2019; 45:299-303. [PMID: 30803985 PMCID: PMC6582739 DOI: 10.1136/medethics-2018-104867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 12/01/2018] [Accepted: 12/12/2018] [Indexed: 05/29/2023]
Abstract
Functional MRI shows promise as a candidate prognostication method in acutely comatose patients following severe brain injury. However, further research is needed before this technique becomes appropriate for clinical practice. Drawing on a clinical case, we investigate the process of obtaining informed consent for this kind of research and identify four ethical issues. After describing each issue, we propose potential solutions which would make a patient's participation in research compatible with her rights and interests. First, we defend the need for traditional proxy consent against two alternative approaches. Second, we examine the impact of the intensive care unit environment on the informed consent process. Third, we discuss the therapeutic misconception and its potential influence on informed consent. Finally, we deal with issues of timing in recruiting participants and related factors which may affect the risks of participation.
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Affiliation(s)
- Tommaso Bruni
- Medizinhistorisches Institut, Universitätsklinikum Bonn, Bonn, Germany
| | - Mackenzie Graham
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Loretta Norton
- Brain and Mind Institute, Western University, London, Ontario, Canada
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Teneille Gofton
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Adrian M Owen
- Brain and Mind Institute, Western University, London, Ontario, Canada
- Rotman Institute of Philosophy, Western University, London, Ontario, Canada
| | - Charles Weijer
- Brain and Mind Institute, Western University, London, Ontario, Canada
- Rotman Institute of Philosophy, Western University, London, Ontario, Canada
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Samuel G, Cribb A, Owens J, Williams C. Relative Values: Perspectives on a Neuroimaging Technology From Above and Within the Ethical Landscape. JOURNAL OF BIOETHICAL INQUIRY 2016; 13:407-18. [PMID: 27334528 PMCID: PMC5021745 DOI: 10.1007/s11673-016-9725-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/29/2015] [Indexed: 06/06/2023]
Abstract
In this paper we contribute to "sociology in bioethics" and help clarify the range of ways sociological work can contribute to ethics scholarship. We do this using a case study of an innovative neurotechnology, functional magnetic resonance imaging, and its use to attempt to diagnose and communicate with severely brain-injured patients. We compare empirical data from interviews with relatives of patients who have a severe brain injury with perspectives from mainstream bioethics scholars. We use the notion of an "ethical landscape" as an analogy for the different ethical positions subjects can take-whereby a person's position relative to the landscape makes a difference to the way they experience and interact with it. We show that, in comparison to studying abstract ethics "from above" the ethical landscape, which involves universal generalizations and global judgements, studying ethics empirically "from the ground," within the ethical landscape foregrounds a more plural and differentiated picture. We argue it is important not to treat empirical ethics as secondary to abstract ethics, to treat on-the-ground perspectives as useful only insofar as they can inform ethics from above. Rather, empirical perspectives can illuminate the plural vantage points in ethical judgments, highlight the "lived" nature of ethical reasoning, and point to all ethical vantage points as being significant. This is of epistemic importance to normative ethics, since researchers who pay attention to the various positions in and trajectories through the ethical landscape are unlikely to think about ethics in terms of abstract agency-as can happen with top-down ethics-or to elide agency with the agency of policymakers. Moreover, empirical perspectives may have transformative implications for people on the ground, especially where focus on the potential harms and benefits they face brings their experiences and interests to the forefront of ethical and policy discussion.
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Affiliation(s)
- Gabrielle Samuel
- Brighton and Sussex Medical School, Falmer, East Sussex, UK.
- Department of Educational Research, Lancaster University, Lancaster, UK.
| | - Alan Cribb
- Department of Education and Professional Studies, King's College London, London, UK
| | - John Owens
- Department of Education and Professional Studies, King's College London, London, UK
| | - Clare Williams
- College of Business, Arts and Social Sciences, Brunel University London, Uxbridge, UK
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Kitzinger C, Kitzinger J. Court applications for withdrawal of artificial nutrition and hydration from patients in a permanent vegetative state: family experiences. JOURNAL OF MEDICAL ETHICS 2016; 42:11-7. [PMID: 26486571 PMCID: PMC4717453 DOI: 10.1136/medethics-2015-102777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 06/23/2015] [Accepted: 07/23/2015] [Indexed: 05/11/2023]
Abstract
Withdrawal of artificially delivered nutrition and hydration (ANH) from patients in a permanent vegetative state (PVS) requires judicial approval in England and Wales, even when families and healthcare professionals agree that withdrawal is in the patient's best interests. Part of the rationale underpinning the original recommendation for such court approval was the reassurance of patients' families, but there has been no research as to whether or not family members are reassured by the requirement for court proceedings or how they experience the process. The research reported here draws on in-depth narrative interviews with 10 family members (from five different families) of PVS patients who have been the subject of court proceedings for ANH-withdrawal. We analyse the empirical evidence to understand how family members perceive and experience the process of applying to the courts for ANH-withdrawal and consider the ethical and practice implications of our findings. Our analysis of family experience supports arguments grounded in economic and legal analysis that court approval should no longer be required. We conclude with some suggestions for how we might develop other more efficient, just and humane mechanisms for reviewing best interests decisions about ANH-withdrawal from these patients.
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Affiliation(s)
| | - Jenny Kitzinger
- School of Journalism, Culture & Media Studies, Cardiff University, Cardiff, UK
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