Ethical difficulties in clinical practice: experiences of European doctors

Hurst, Samia; Perrier, Arnaud; Pegoraro, Renzo; Reiter-Theil, Stella; Før­de, Rei­dun; Slowther, Anne‐Marie; Garrett‐Mayer, Elizabeth; Danis, Marion

doi:10.1136/jme.2005.014266

Cited by 160 publications

(165 citation statements)

References 30 publications

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“…For example, a hospital ward with a hierarchic structure and unsupportive climate might have a different impact on this matter than a supportive work environment with a network of consistent boundaries regarding the psychosocial work climate. This is in line with previous research where physicians are shown to have different attitudes to and practice of confidentiality [19,20], their professional role [21,22] and coping strategies used to deal with ethical [23,24] and emotional [25] discomfort in their work. Based on the current results, these factors are likely to be associated with how physician manages emotionally-charged work situations and confidentiality.…”

Section: The Overlap Between Personal and Professional Relationshipssupporting

confidence: 76%

Exploring the subjective burden of confidentiality among physicians in Norway

Tevik¹,

Håkon²

2011

Health

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Background: Concern about protecting patient privacy is proposed to be a barrier for physiccians to talk about emotional distress from their professional experiences. This makes it difficult for many physicians to utilize and fully benefit from different network of social support. The subjective burden of confidentiality is reported to be associated with physician's health and wellbeing. Aims: To gain knowledge about factors in the in personal and professional sphere that can be associated with the subjective burden of confidentiality. Methods: Qualitative semistructured interviews with 14 general practitioners and hospital physicians in Norway. Examination of transcribed verbatim interviews using qualitative content analysis. Results: The subjective burden of confidentiality is likely linked with factors such as perception of professional role, social support from colleagues, partners and friends; size of patient population, organizational factors and work environment, and the overlap between personal and professsional relationships. Conclusions: Addressing the interaction of emotional demands and patient confidentiality is important to study successful coping with distress from physician's professional experiences.

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Section: The Overlap Between Personal and Professional Relationshipssupporting

confidence: 76%

Exploring the subjective burden of confidentiality among physicians in Norway

Tevik¹,

Håkon²

2011

Health

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“…Legene er sentrale i behandlingsteamet, viktige premissleverandører, sentrale for pasient og pårørende og, ikke minst, den som ofte står ansvarlig for etisk vanskelige beslutninger. Vi vet at også leger i kommunehelsetjenesten opplever moralsk stress (43) og at de ofte mangler strategier og systemer for å hånd-tere slike utfordringer (44). Det er nødvendig å inkludere leger i den nasjonale satsingen på etikk i kommunehelsetjenesten.…”

Section: Pilotstudienunclassified

Etikk i sykehjem og hjemmetjenester

Bollig¹,

Pedersen²,

Førde

2009

Sykepleien

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Bakgrunn: Politikere og helsepersonell i Norge ønsker å styrke systematisk etikkarbeid i sykehjem og hjemmetjenester. Sentrale etiske utfordringer og erfaringer med etikkarbeid fra feltet presenteres.Hensikt: Å undersøke etiske utfordringer og systematisk etikkarbeid i sykehjem og hjemmetjenester.Metode: Det ble foretatt en systematisk litteraturgjennomgang av empirisk forskning om etiske utfordringer og systematisk etikkarbeid i sykehjem og hjemmetjenester. På grunnlag av litteraturgjennomgangen ble det utviklet et spørreskjema. Skjemaet ble benyttet i en pilotstudie der 19 ledere og helsepersonell tilknyttet sykehjem og hjemmetjenester ble telefonintervjuet om etiske utfordringer og etikkarbeid.Resultater: Litteraturgjennomgangen viste at det finnes mange og komplekse etiske utfordringer i sykehjem og hjemmetjenester. Etiske dilemmaer som følge av ressursmangel og etiske utfordringer ved livets slutt ble oftest beskrevet av informantene. De etiske utfordringene beskrevet i pilotstudien samsvarer med det som er beskrevet fra andre land. For å styrke etikkarbeidet ønsket informantene kompetanseheving i etikk for alle medarbeidere, møteplasser for å diskutere etiske utfordringer, kompetent veiledning og forskning om etikk. Systematisk etikkarbeid synes relativt lite utviklet i sykehjem og hjemmetjenester i Norge.Konklusjon: Systematisk etikkarbeid bør styrkes i sykehjem og hjemmetjenester. Dette kan bedre håndteringen av vanskelige etiske utfordringer og høyne kvaliteten på helsetjenestene. Det er viktig få med ufaglaerte, leger og brukerne i dette arbeidet, og å evaluere de tiltak som igangsettes. Hva tilfører artikkelen?Studien viser at det er behov for å utvikle systematiske strategier for å kunne håndtere etiske utfordringer på en bedre måte i sykehjem og hjemmetjenester.

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“…Treatment decisions regarding patients with advanced cancer pose complex medical and ethical challenges [1][2][3][4][5][6]. Evidence indicates that there is an increasing aggressiveness concerning the application of cancer-specific treatment near the end of life [7].…”

Section: Introductionmentioning

confidence: 99%

“Well, I Think There Is Great Variation…”: A Qualitative Study of Oncologists' Experiences and Views Regarding Medical Criteria and Other Factors Relevant to Treatment Decisions in Advanced Cancer

et al. 2013

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Background. Surveys indicate considerable variation regarding the provision of cancer treatment at the end of life. The variation cannot be fully explained by differences concerning the clinical situation or patients' preferences. The aim of this qualitative study was to explore medical oncologists' experiences with advanced cancer, as well as their views of the relevance of medical and nonmedical criteria for decisions about limiting treatment.Methods. Qualitative in-depth interviews were conducted with physicians working in medical oncology in tertiary care hospitals or district general hospitals in England. Purposive sampling and qualitative analysis were performed. Implications for Practice: Survey research indicates that there is considerable variation concerning treatment at the end of life that cannot be explained by clinical features or patients' individual preferences. This qualitative study adds to existing literature by providing information about physicians' distinctions (i.e., "active treatment" versus "palliative care") and related clinical as well as ethical implications in the context of care for patients with advanced cancer. In addition, the interviewed oncologists report a number of value-laden non-medical factors that are viewed as influential for decisions about the provision or limitation of cancer treatment against the background of often scarce evidence. The findings of this study suggest that, in clinical practice, multi-professional team discussions on value aspects of decision making and a systematic gathering and analysis of clinical data that can be applied to end-of-life practice may contribute to an improved evidence-and ethics-based treatment decision making in advanced cancer. Results. Physicians reported that a number of nonmedical

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Ethical difficulties in clinical practice: experiences of European doctors

Abstract: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries.

Cited by 160 publications

References 30 publications

Exploring the subjective burden of confidentiality among physicians in Norway

Exploring the subjective burden of confidentiality among physicians in Norway

Etikk i sykehjem og hjemmetjenester

“Well, I Think There Is Great Variation…”: A Qualitative Study of Oncologists' Experiences and Views Regarding Medical Criteria and Other Factors Relevant to Treatment Decisions in Advanced Cancer

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