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  • Girma Kebede, Betlehem, et al. (författare)
  • Communicative challenges among physicians, patients, and family caregivers in cancer care: An exploratory qualitative study in Ethiopia
  • 2020
  • Ingår i: PLoS ONE. - 1932-6203. ; 15:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Cancer is a growing concern in Ethiopia. Though communication is essential for the treatment process, few studies have looked at communication in Ethiopian cancer care. Due to the large number of patients and scarcity of resources, it is vital to understand how to manage consultations in order to effectively help as many patients as possible in this challenging work environment. Thus, research is needed to analyze and understand the communicative challenges experienced by physicians, patients, and family caregivers, in order to successfully handle patient care in practice. Objective We explore communication in Ethiopian cancer care and present the main challenges faced by physicians, patients, and family caregivers. Methods This explorative qualitative study was conducted at the Oncology Department of the Tikur Anbessa (Black Lion) Specialized Teaching Hospital (TASH) in Addis Ababa, Ethiopia. A triangulation of data collection methods was used: 91 audio-recorded, semi-structured interviews and 21 video-recordings of authentic interactions during hospital rounds. The aim was to obtain as complete a picture as possible of communication from the perspectives of physicians, patients, and family caregivers. The interviews were analyzed using thematic content analysis and the identified themes were supported by excerpts from the transcribed recordings. Results Eight themes emerged from the data. Workload and time pressure, in combination with restricted space for privacy, limited the possibilities for physicians to deliver detailed information and provide emotional support. Furthermore, patient literacy levels, in combination with no or little cancer awareness, financial problems, reliance on traditional and religious treatments, the stigma of cancer, and a fatalistic attitude, resulted in delays in patients seeking care and participating in positive health behaviors, and, subsequently, often resulted in an unwillingness to openly discuss problems with physicians and adhere to treatment. The study also illustrates the paramount role of family in physician-patient communication in Ethiopia. Though family caregivers provide a valuable interpreting support when patients have limited language skills, they can also prevent patients from sharing information with physicians. Another important finding is that family caregivers were often responsible for making decisions about treatment and avoided telling patients about a poor prognosis, believing that conveying bad news may upset them. All of these themes have important implications for the role of ethically acceptable communication in patient-centered care. Conclusions This study has identified a number of serious challenges for successful and ethically acceptable health communication in Ethiopian cancer care. The study contributes to our understanding of the complexity around the role of family, combined with patients’ dependency on family members for communication, support, and access to care, which creates particular ethical dilemmas for the medical staff. The questions raised by this study concern how to organize consultations to achieve patient-centered health communication, while maintaining a constructive alliance with the family and not jeopardizing the patient’s continued access to care. The integration of communication training for medical students in Ethiopia, with a focus on ethical guidelines for family-centered patient consultation suitable for these circumstances, would be an essential step.
  • Munthe, Christian, 1962- (författare)
  • A New Ethical Landscape of Prenatal Testing: Individualizing Choice to Serve Autonomy and Promote Public Health: A Radical Proposal
  • 2015
  • Ingår i: Bioethics. - 0269-9702 .- 1467-8519. ; 29:1, s. 36-45
  • Tidskriftsartikel (refereegranskat)abstract
    • A new landscape of prenatal testing (PNT) is presently developing, including new techniques for risk-reducing, non-invasive sampling of foetal DNA and drastically enhanced possibilities of what may be rapidly and precisely analysed, surrounded by a growing commercial genetic testing industry and a general trend of individualization in healthcare policies. This article applies a set of established ethical notions from past debates on PNT for analysing PNT screening-programmes in this new situation. While some basic challenges of PNT stay untouched, the new development supports a radical individualization of how PNT screening is organized. This reformation is, at the same time, difficult to reconcile with responsible spending of resources in a publicly funded healthcare context. Thus, while the ethical imperative of individualization holds and applies to PNT, the new landscape of PNT provides reasons to start rolling back the type of mass-screening programmes currently established in many countries. Instead, more limited offers are suggested, based on considerations of severity of conditions and optimized to simultaneously serve reproductive autonomy and public health within an acceptable frame of priorities. The new landscape of PNT furthermore underscores the ethical importance of supporting and including people with disabilities. For the very same reason, no ban on what may be analysed using PNT in the new landscape should be applied, although private offers must, of course, conform to strict requirements of respecting reproductive autonomy and what that means in terms of counselling.
  • Munthe, Christian, 1962- (författare)
  • Will IVF ever be the norm?
  • 2014
  • Ingår i: Future of IVF - A Brave New World? ESHRE symposium, September 26-27, Stockholm.
  • Konferensbidrag (övrigt vetenskapligt)
  • Herlitz, Anders, 1981-, et al. (författare)
  • The Counseling, Self-care, Adherence Approach to Person-centered Care and Shared Decision Making: Moral Psychology, Executive Autonomy, and Ethics in Multi-dimensional Care Decisions
  • 2016
  • Ingår i: Health Communication. - 1041-0236 .- 1532-7027. ; 31:8, s. 964-973
  • Tidskriftsartikel (refereegranskat)abstract
    • This article argues that standard models of person-centred care (PCC) and shared decision making (SDM) rely on simplistic, often unrealistic assumptions of patient capacities that entail that PCC/SDM might have detrimental effects in many applications. We suggest a complementary PCC/SDM approach to ensure that patients are able to execute rational decisions taken jointly with care professionals when performing self-care. Illustrated by concrete examples from a study of adolescent diabetes care, we suggest a combination of moral and psychological considerations to support the claim that standard PCC/SDM threatens to systematically undermine its own goals. This threat is due to a tension between the ethical requirements of SDM in ideal circumstances and more long-term needs actualized by the context of self-care handled by patients with limited capacities for taking responsibility and adhere to their own rational decisions. To improve this situation, we suggest a counseling, self-care, adherence approach to PCC/SDM, where more attention is given to how treatment goals are internalized by patients, how patients perceive choice situations, and what emotional feedback patients are given. This focus may involve less of a concentration on autonomous and rational clinical decision making otherwise stressed in standard PCC/SDM advocacy.
  • Munthe, Christian, 1962- (författare)
  • Patient Collaboration and Person Centeredness in Forensic Psychiatric Care: An Ethical Map
  • 2017
  • Ingår i: 35th International Congress on Law and Mental Health, July 9-14, 2017, Prague. Abstracts of the XXX Vth International Congress on Law and Mental Health / David N. Weisstub Editor.
  • Konferensbidrag (övrigt vetenskapligt)abstract
    • There is increasing interest in applying ideas from person centred care (PCC) in forensic psychiatry, including increased room for patients to collaborate in the care design. However, standard ethical assumptions in PCC about capacities of patients, as well as a traditional health care ethical context, departs significantly from the forensic psychiatric situation. Forensic psychiatric care is beset with restrictions of personal freedom and motivated partly by patients' incapacity to take responsibility brought by mental ill-health, usually within limits from criminal law, public safety and court orders. The care is supposed to change patients to become more autonomous and responsible in order for the restrictions on freedom to be justifiably relaxed or removed. Doing so may involve some room for independent decision-making by patients, using their responsibility capacities, but PCC opens up for much more far-reaching empowerment of patients, e.g., regarding the goals of care and the acceptance of applied methods. Therefore, there is a manifold increase of the ethical complexity creating tensions for PCC already in standard health care. This presentation provides a map of these ethical complexities, focusing especially on the issue of how the central notions of patient empowerment and shared decision-making should imply within forensic psychiatric care.
  • Ahlzen, Rolf (författare)
  • Illness as unhomelike being-in-the-world? : Phenomenology and medical practice
  • 2011
  • Ingår i: Medicine, Health care and Philosophy. - Springer. - 1386-7423 .- 1572-8633. ; 14:3, s. 323-331
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Scientific medicine has been successful by ways of an ever more detailed understanding and mastering of bodily functions and dysfunctions. Biomedical research promises new triumphs, but discontent with medical practice is all around. Since several decades this has been acknowledged and discussed. The philosophical traditions of phenomenology and hermeneutics have been proposed as promising ways to approach medical practice, by ways of a richer understanding of the meaning structures of health and illness. In 2000, Swedish philosopher Fredrik Svenaeus published a book where he proposes that the phenomenological hermeneutics of Martin Heidegger and also the reflections on health and illness of Hans-Georg Gadamer offer important ways to approach the nature of medicine. In particular, Svenaeus argues that the goal of medicine is to promote and restore health, and that health ought to be seen as "homelike being-in-the-world". Unhealth, illness, consequently should be understood as a situation where a person's "being-in-the-world" in characterized by that lack of the rhythm, balance and "tune" of everyday living that characterizes not "being at home". In this article, Svenaeus' position is briefly outlined. Questions are raised whether "unhomelikeness" is to be seen as a metaphor, and, if so, if it is a fruitful such. Furthermore, I discuss whether or not a discourse on health and illness in these terms may be misleading in a situation where the ontological presuppositions of Heidegger are lost out of sight and the popular understanding of health psychology predominates. I also approach the question whether Svenaeus' assumptions may inadvertently lead us to an unjustifiably broad understanding of the tasks of medicine. It is finally concluded that Svenaeus phenomenological and hermeneutical approach is both interesting and promising. There are, however, several questions that ought to be pursued further, and the step from philosophical analysis to everyday clinical discourse may be unexpectedly long and risky.</p>
  • Benkel, Inger, et al. (författare)
  • Palliativ vård
  • 2016
  • Bok (övrigt vetenskapligt)
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