Shah Seema, Malik Faisal, Senturia Kristen D, Lind Cara, Chalmers Kristen, Yi-Frazier Joyce, Pihoker Catherine, Wright Davene
Advanced General Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, United States.
J Med Ethics. 2020 Dec 7. doi: 10.1136/medethics-2020-106428.
To assess ethical concerns associated with participation in a financial incentive (FI) programme to help adolescents with type 1 diabetes improve diabetes self-management.
Focus groups with 46 adolescents with type 1 diabetes ages 12-17 and 38 of their parents were conducted in the Seattle, Washington metropolitan area. Semistructured focus group guides addressed ethical concerns related to the use of FI to promote change in diabetes self-management. Qualitative data were analysed and emergent themes identified.
We identified three themes related to the ethical issues adolescents and parents anticipated with FI programme participation. First, FI programmes may variably change pressure and conflict in different families in ways that are not necessarily problematic. Second, the pressure to share FIs in some families and how FI payments are structured may lead to unfairness in some cases. Third, some adolescents may be likely to fabricate information in any circumstances, not simply because of FIs, but this could compromise the integrity of FI programmes relying on measures that cannot be externally verified.
Many adolescents with type 1 diabetes and their parents see positive potential of FIs to help adolescents improve their self-management. However, ethical concerns about unfairness, potentially harmful increases in conflict/pressure and dishonesty should be addressed in the design and evaluation of FI programmes.
评估参与一项经济激励（FI）计划以帮助1型糖尿病青少年改善糖尿病自我管理所涉及的伦理问题。
在华盛顿州西雅图市都会区，对46名年龄在12至17岁的1型糖尿病青少年及其38名家长进行了焦点小组访谈。半结构化焦点小组指南涉及与使用经济激励措施促进糖尿病自我管理改变相关的伦理问题。对定性数据进行了分析并确定了新出现的主题。
我们确定了与青少年和家长预期参与经济激励计划所涉及的伦理问题相关的三个主题。首先，经济激励计划可能会以不一定有问题的方式在不同家庭中以不同方式改变压力和冲突。其次，一些家庭中分享经济激励的压力以及经济激励支付的结构方式在某些情况下可能导致不公平。第三，一些青少年可能在任何情况下都有可能编造信息，不仅仅是因为经济激励，但这可能会损害依赖无法外部核实的措施的经济激励计划的完整性。
许多1型糖尿病青少年及其家长看到了经济激励措施在帮助青少年改善自我管理方面的积极潜力。然而，在经济激励计划的设计和评估中应解决对不公平、冲突/压力潜在有害增加以及不诚实的伦理担忧。
