Shawahna Ramzi
Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, State of Palestine.
An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, State of Palestine.
Evid Based Complement Alternat Med. 2018 Dec 23;2018:2315938. doi: 10.1155/2018/2315938. eCollection 2018.
In daily practice, healthcare practitioners face many challenges in ethical and professional decision making. Currently, little is known on the ethical and professional deliberations and weighing benefits against risks in daily complementary and alternative medicine (CAM) practice. The aim of this study was to combine the Utrecht method and the Analytic Hierarchy Process (AHP) in deliberations, weighing benefits against risks of using ginger for a pregnant woman suffering nausea and vomiting of pregnancy (NVP) along with other comorbidities.
A hypothetical case was constructed using the twelve tips for constructing dilemma case-based assessment. Three CAM practitioners, two physicians, three pharmacists, and two patients were recruited, and the Utrecht and the AHP methods were combined and used to deliberate and weigh benefits against risks of using ginger for the presented case.
Responses from the ten panelists were obtained. Priority ratings showed significantly higher scores (-value < 0.001) for alleviating symptoms of NVP (30.7% ± 16.6%) compared to other potential benefits. Increasing the risk of bleeding was given significantly higher (-value < 0.0001) weight scores (24.7% ± 13.5%) than other potential side effects. Potential risk of spontaneous abortion and risk of impairment of fetal development were given higher (-value < 0.001) weight scores than risk of fetal hypoglycemia. When benefits were compared against side effects and risks to the fetus and pregnancy, potential benefits were given higher (-value < 0.001) weight scores (72.3% ± 5.2%).
Considering the anticipated benefits and risks, a shared decision was made to use ginger in the case presented. The woman should also be informed of the potential side effects and risks of using ginger. The use of this combined method might promote openness and transparency in making shared decisions for healthcare providers and patients.
在日常医疗实践中，医疗从业者在伦理和专业决策上面临诸多挑战。目前，对于日常补充和替代医学（CAM）实践中的伦理和专业考量以及权衡利弊知之甚少。本研究的目的是将乌得勒支方法和层次分析法（AHP）结合起来，用于考量给一位患有妊娠恶心和呕吐（NVP）以及其他合并症的孕妇使用生姜的利弊权衡。
使用构建基于困境案例评估的十二条提示构建一个假设案例。招募了三名补充和替代医学从业者、两名医生、三名药剂师和两名患者，并将乌得勒支方法和层次分析法结合起来，用于对所呈现案例中使用生姜的利弊进行考量和权衡。
获得了十位小组成员的回复。优先级评分显示，与其他潜在益处相比，缓解NVP症状的得分（30.7% ± 16.6%）显著更高（P值 < 0.001）。与其他潜在副作用相比，出血风险增加的权重得分（24.7% ± 13.5%）显著更高（P值 < 0.0001）。自然流产的潜在风险和胎儿发育受损的风险的权重得分高于胎儿低血糖风险（P值 < 0.001）。当将益处与对胎儿和妊娠的副作用及风险进行比较时，潜在益处的权重得分更高（P值 < 0.001）（72.3% ± 5.2%）。
考虑到预期的益处和风险，对于所呈现案例做出了使用生姜的共同决策。还应告知该女性使用生姜的潜在副作用和风险。这种联合方法的使用可能会促进医疗服务提供者和患者在做出共同决策时的开放性和透明度。
