| 1. |
- Ahmadi, Zainab, et al.
(författare)
-
Smoking and home oxygen therapy : a review and consensus statement from a multidisciplinary Swedish taskforce
- 2024
-
Ingår i: European Respiratory Review. - : European Respiratory Society. - 0905-9180 .- 1600-0617. ; 33:171
-
Forskningsöversikt (refereegranskat)abstract
- Background: Home oxygen therapy (HOT) improves survival in patients with hypoxaemic chronic respiratory disease. Most patients evaluated for HOT are former or active smokers. Oxygen accelerates combustion and smoking may increase the risk of burn injuries and fire hazards; therefore, it is considered a contraindication for HOT in many countries. However, there is variability in the practices and policies regarding this matter. This multidisciplinary Swedish taskforce aimed to review the potential benefits and risks of smoking in relation to HOT, including medical, practical, legal and ethical considerations.Methods: The taskforce of the Swedish Respiratory Society comprises 15 members across respiratory medicine, nursing, medical law and ethics. HOT effectiveness and adverse risks related to smoking, as well as practical, legal and ethical considerations, were reviewed, resulting in five general questions and four PICO (population–intervention–comparator–outcome) questions. The strength of each recommendation was rated according to the GRADE (grading of recommendation assessment, development and evaluation) methodology.Results: General questions about the practical, legal and ethical aspects of HOT were discussed and summarised in the document. The PICO questions resulted in recommendations about assessment, management and follow-up of smoking when considering HOT, if HOT should be offered to people that meet the eligibility criteria but who continue to smoke, if a specific length of time of smoking cessation should be considered before assessing eligibility for HOT, and identification of areas for further research.Conclusions: Multiple factors need to be considered in the benefit/risk evaluation of HOT in active smokers. A systematic approach is suggested to guide healthcare professionals in evaluating HOT in relation to smoking.
|
|
| 2. |
- Björk, Joar
(författare)
-
"It is very hard to just accept this" : a qualitative study of palliative care teams' ethical reasoning when patients do not want information
- 2024
-
Ingår i: BMC Palliative Care. - : BioMed Central (BMC). - 1472-684X. ; 23:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe aim of this study was to explore how palliative care staff reason about the autonomy challenge that arises when a patient who has first said he wants full information appears to change his mind and rejects being informed.MethodsThe study had a qualitative and exploratory design. Participants (physicians, registred nurses, social workers, physiotherapists and occupational therapists) were recruited from palliative care teams in southern Sweden. Six separate focus group interviews with a total number of 33 participants were conducted. The teams were asked to discuss a fictional case of a man who first wants, then rejects, information about his situation. The interviews were audiotaped and transcribed verbatim. Reflexive thematic analysis following Braun and Clarke was undertaken to analyse data.ResultsThe analysis resulted in three themes: Patients have a right to reject information, Questioning whether this patient WANTS to reject information and There are other values at stake, too. Although participants endorsed a right to reject information, they were unsure whether this right was relevant in this situation, and furthermore felt that it should be balanced against counteracting factors. The effect of such balancing was that participants would aim to find a way to present relevant information to the patient, but in a probing and flexible way.ConclusionsIn their work with dying patients, palliative care staff meet many autonomy challenges. When faced with a choice to withhold information as per a patient’s wishes, or to provide information with the patient’s best interest in mind, staff find it hard to balance competing values. Staff also find it hard to balance their own interests against a purely professional stance. The overall strategy seems to be to look for caring ways to impart the information.
|
|
| 3. |
- Björk, Joar
(författare)
-
Just responsibilities? On responsibility for health in Swedish healthcare priority setting
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overarching aim of this project is to explore, empirically as well as philosophically, the arguments for and against making Swedish healthcare priority setting decisions sensitive to patients’ degree of responsibility for their ill health. Arguments of interest are those expressed by important stakeholders in the debate – physicians, lay people and, as this is a matter of some theoretical importance, bioethicists. Article I: An experimental vignette methodology study. The two versions of the vignette differed in one aspect: the patient was a non-smoker/patient was a smoker. The aim was to investigate whether the willingness to offer a novel, expensive and moderately life prolonging treatment to one patient depends upon whether this patient was a non-smoker or a smoker. Sample: 1193 physicians and 962 citizens. Results: Response rate 50,9%. Respondents were more willing to offer a novel, expensive and moderately life prolonging treatment if the patient was a non-smoker than a smoker. This statistically significant difference in willingness to offer treatment was irrespective of considerations of capacity to benefit, and held among citizens (83,8% vs 68,7%), oncologists (81,8% vs 64,9%) and GPs (69,1% vs 56,3%), but not among pulmonologists (72,9% vs 67,2%). Conclusion: Members of the citizenry and most physician specialities are more willing to offer treatment to a non-smoker than to a smoker. This is in conflict with the Swedish Ethical Platform for priority setting. Somewhat paradoxically, the lower willingness to offer treatment to the smoking patient is unrelated to considerations of responsibility among physician respondents (but not among citizens). Article II: An experimental vignette methodology study using parts of the data material from Article I (only physician respondents). The aim was to investigate whether there is a difference in the perception of a medical indication for treatment of a non-smoking or smoking patient depending upon the respondent’s own attitude towards the treatment (as measured by whether the respondent’s trust in healthcare would change – for better or worse – if treatments such as this were to become routine). Sample: 1193 physicians. Results: Response rate 54,1%. Only physicians whose trust would change differed in their willingness to offer the treatment depending upon whether the patient was a non-smoker or a smoker (78% vs 57%). Among physicians whose trust would be unchanged there was no corresponding statistically significant difference (70% vs 67%). Similarly, only physicians whose trust would change based their judgment of whether it was medically indicated to provide the treatment (in part) on the patient’s smoking status. These physicians judged treatment “medically indicated” more often in the case of the non-smoking patient than the smoking patient (67% vs 50%). Among physicians whose trust would be unchanged there was no corresponding difference (53% vs 53%). Among all categories of physicians the notion of “medical indications” was used in a widely differing ways. Conclusion: Physicians whose trust in healthcare would be affected by a change in treatment routine are more likely to base treatment decisions, as well as judgments of medical indication, on medically irrelevant factors. Physicians seem to use the term “medical indications” in an ambiguous manner. Article III: A vignette-based questionnaire study. The aim was to investigate the support for making planned surgery conditional upon smoking cessation prior to surgery, as well as the reasons given in support or rejection of this. Sample: 795 physicians and 485 citizens. Results: Response rate 56,6%. Most respondents (physicians as well as citizens) agreed that planned surgery should be made conditional upon the vignette patient’s smoking cessation (83,9% and 86,6%, respectively). Additional findings include that the most common reason for supporting a demand for smoking cessation was the (assumed) increased peri-operative risks, but that another weighty consideration was that smoking cessation would bring about long-term positive effects. Finally, analysis of the written comments indicated that the support referenced above may to a great extent be for the less harsh “recommendation of smoking cessation” policy rather than for the harsher “requirement of smoking cessation” policy. Conclusion: There is a strong support for some kind of policy of smoking cessation prior to planned surgery, but it is unclear whether respondents support a policy of requiring or merely recommending smoking cessation. Reasons for supporting this policy include the peri-operative risks as well as long-term health gains. There is risk that paternalistic sentiments influence support for policies of smoking cessation. Article IV: A philosophical (non-empirical) article. The aim was to discuss several possible challenges when applying Luck Egalitarianism as a guide for healthcare policy, using considerations that appear reasonable and relevant even to Luck Egalitarians themselves. Conclusion: Luck Egalitarianism faces great challenges when applied to the healthcare setting. Some of these challenges may be overcome: for instance, it may be possible to define “imprudent actions” so that Luck Egalitarianism escapes charges of moral arbitrariness. Other challenges including how to decide between the ex ante and ex post operationalisations of Luck Egalitarianism, and setting the threshold for abandonment, are more difficult to overcome. Any way of responding to these challenges are likely to be unattractive even to Luck Egalitarians themselves. Article V: An interview study using the phenomenographic method of data analysis. The aim was to explore physicians’ understanding of the notion of a personal responsibility for health. Sample: 14 General Practitioners. Results: All participants found the notion of personal responsibility for health relevant to their clinical practice. There was a wide range of understandings of this notion. The understandings differed as to the perceived origins of responsibility as well as the expressions of responsibility. The GP herself was perceived as a key player in shaping and defining the construct of patients’ personal responsibility for health. Considerations of patients’ personal responsibilities may trigger strong emotional reactions in GPs. Conclusion: The notion of personal responsibility for health is relevant but complex, and discussions about personal responsibility for health are emotionally challenging.
|
|
| 4. |
- Godskesen, Tove, et al.
(författare)
-
Challenges regarding informed consent in recruitment to clinical research : a qualitative study of clinical research nurses' experiences
- 2023
-
Ingår i: Trials. - : BioMed Central (BMC). - 1745-6215. ; 24
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Clinical research nurses (CRNs) have first-hand experience with ethical challenges and play a crucial role in upholding ethical conduct and adherence to the principles of informed consent in clinical research. This study explores the ethical challenges encountered by CRNs in the process of obtaining informed consent for clinical research.Methods: A qualitative exploratory design. Semistructured interviews (n = 14) were conducted with diverse CRNs in Sweden. These CRNs covered a wide range of research fields, including pharmaceutical and academic studies, interventions, and observational research, spanning different trial phases, patient categories, and medical conditions. The interviews were analysed using inductive qualitative content analysis.Results:The analysis identified three main categories: (i) threats to voluntariness, (ii) measures to safeguard voluntariness, and (iii) questionable exclusion of certain groups. CRNs face challenges due to time constraints, rushed decisions, information overload, and excessive reliance on physicians' recommendations. Overestimating therapeutic benefits in stages of advanced illness emerged as a risk to voluntariness. CRNs outlined proactive solutions, such as allowing ample decision-making time and offering support, especially for terminally ill patients. Concerns were also voiced about excluding certain demographics, such as those with language barriers or cognitive impairments.Conclusions: In conclusion, upholding ethical research standards requires recognising various factors affecting patient voluntariness. Researchers and CRNs should prioritise refining the informed consent process, overcoming participation challenges, and aligning scientific rigour with personalised care. Additionally, a concerted effort is vital to meet the diverse needs of patient populations, including equitable inclusion of individuals with language barriers or cognitive limitations in clinical studies. These findings have significant implications for enhancing the ethics of clinical research and advancing person-centred care.
|
|
| 5. |
- Gustavsson, Erik, 1982-, et al.
(författare)
-
The Ethical Relevance of "Alternatives" in Health Care Priority Setting - The Case of Preexposure Prophylaxis (PrEP) of HIV
- 2022
-
Ingår i: The Yale Journal of Biology and Medicine. - : Yale Journal of Biology and Medicine, Inc.. - 0044-0086 .- 1551-4056. ; 95:3, s. 359-365
-
Tidskriftsartikel (refereegranskat)abstract
- Preexposure prophylaxis for HIV is a drug that reduces the risk for an HIV-negative person to acquire HIV if taken prior to sex. It has been suggested that it is important for resource allocation decisions that there are alternatives (such as abstinence, masturbation, etc.) for individuals potentially benefitted by this prophylaxis. In this paper we explore this idea from an ethical perspective in relation to three notions often discussed in priority setting ethics, namely responsibility, outcomes, and severity of disease. While the relevance of alternatives may be explained in terms by responsibility-sensitive priority setting, such a view comes with several challenges. We then discuss two other ways in which this intuition could be better explained: (a) in terms of total outcome of health, and (b) in terms of severity of the condition.
|
|
| 6. |
|
|
