Hannover Medical School, Hannover, Germany.
PLoS Med. 2013 Aug;10(8):e1001498. doi: 10.1371/journal.pmed.1001498. Epub 2013 Aug 13.
Clinical practice guidelines (CPGs) aim to improve professionalism in health care. However, current CPG development manuals fail to address how to include ethical issues in a systematic and transparent manner. The objective of this study was to assess the representation of ethical issues in general CPGs on dementia care.
To identify national CPGs on dementia care, five databases of guidelines were searched and national psychiatric associations were contacted in August 2011 and in June 2013. A framework for the assessment of the identified CPGs' ethical content was developed on the basis of a prior systematic review of ethical issues in dementia care. Thematic text analysis and a 4-point rating score were employed to assess how ethical issues were addressed in the identified CPGs. Twelve national CPGs were included. Thirty-one ethical issues in dementia care were identified by the prior systematic review. The proportion of these 31 ethical issues that were explicitly addressed by each CPG ranged from 22% to 77%, with a median of 49.5%. National guidelines differed substantially with respect to (a) which ethical issues were represented, (b) whether ethical recommendations were included, (c) whether justifications or citations were provided to support recommendations, and (d) to what extent the ethical issues were explained.
Ethical issues were inconsistently addressed in national dementia guidelines, with some guidelines including most and some including few ethical issues. Guidelines should address ethical issues and how to deal with them to help the medical profession understand how to approach care of patients with dementia, and for patients, their relatives, and the general public, all of whom might seek information and advice in national guidelines. There is a need for further research to specify how detailed ethical issues and their respective recommendations can and should be addressed in dementia guidelines. Please see later in the article for the Editors' Summary.
临床实践指南（CPGs）旨在提高医疗保健的专业性。然而，现行的 CPG 开发手册未能解决如何以系统和透明的方式纳入伦理问题。本研究的目的是评估一般 CPG 中关于痴呆症护理的伦理问题的代表性。
为了确定关于痴呆症护理的国家 CPG，于 2011 年 8 月和 2013 年 6 月搜索了五个指南数据库，并联系了国家精神病学协会。根据对痴呆症护理中的伦理问题的系统回顾，制定了评估所确定 CPG 的伦理内容的框架。采用主题文本分析和 4 分制评分来评估所确定的 CPG 中如何解决伦理问题。纳入了 12 项国家 CPG。通过先前的系统回顾确定了 31 项痴呆症护理中的伦理问题。每个 CPG 明确解决的这些 31 个伦理问题的比例范围为 22%至 77%，中位数为 49.5%。国家指南在以下方面存在很大差异：（a）代表哪些伦理问题，（b）是否包括伦理建议，（c）是否提供了支持建议的理由或引文，以及（d）在多大程度上解释了伦理问题。
国家痴呆症指南在处理伦理问题方面不一致，有些指南包括大多数，有些则包括少数。指南应解决伦理问题以及如何处理这些问题，以帮助医学专业人员了解如何处理痴呆症患者的护理问题，同时为患者、他们的亲属和公众提供信息和建议，他们都可能在国家指南中寻求信息和建议。需要进一步研究，以确定如何在痴呆症指南中详细处理伦理问题及其各自的建议。请稍后在文章中查看编辑摘要。
