Schofield Guy, Dittborn Mariana, Huxtable Richard, Brangan Emer, Selman Lucy Ellen
Centre for Ethics in Medicine, Bristol Medical School, University of Bristol, Bristol, UK.
Paediatric Bioethics Service, Great Ormond Street Hospital, London, UK.
Palliat Med. 2021 Feb;35(2):315-334. doi: 10.1177/0269216320974277. Epub 2020 Dec 10.
Ethical issues arise daily in the delivery of palliative care. Despite much (largely theoretical) literature, evidence from specialist palliative care practitioners about day-to-day ethical challenges has not previously been synthesised. This evidence is crucial to inform education and adequately support staff.
To synthesise the evidence regarding the ethical challenges which specialist palliative care practitioners encounter during clinical practice.
Systematic review with narrative synthesis (PROSPERO registration CRD42018105365). Quality was dual-assessed using the Mixed-Methods Appraisal Tool. Tabulation, textural description, concept mapping and thematic synthesis were used to develop and present the narrative.
Seven databases (MEDLINE, Philosopher's Index, EMBASE, PsycINFO, LILACS, Web of Science and CINAHL) were searched from inception to December 2019 without language limits. Eligible papers reported original research using inductive methods to describe practitioner-reported ethical challenges.
A total of 8074 records were screened. Thirteen studies from nine countries were included. Challenges were organised into six themes: application of ethical principles; delivering clinical care; working with families; engaging with institutional structures and values; navigating societal values and expectations; philosophy of palliative care. Challenges related to specific scenarios/contexts rather than the application of general ethical principles, and occurred at all levels (bedside, institution, society, policy).
Palliative care practitioners encounter a broad range of contextual ethical challenges, many of which are not represented in palliative care ethics training resources, for example, navigating institutional policies, resource allocation and inter-professional conflict. Findings have implications for supporting ethical practice and training practitioners. The lack of low- and middle- income country data needs addressing.
在提供姑息治疗的过程中，伦理问题每天都会出现。尽管有大量（主要是理论性的）文献，但此前尚未综合来自专科姑息治疗从业者关于日常伦理挑战的证据。这一证据对于开展教育和充分支持工作人员至关重要。
综合关于专科姑息治疗从业者在临床实践中遇到的伦理挑战的证据。
采用叙述性综合的系统评价（PROSPERO注册号CRD42018105365）。使用混合方法评估工具进行双重质量评估。采用列表、文本描述、概念映射和主题综合来形成和呈现叙述内容。
检索了七个数据库（MEDLINE、哲学家索引、EMBASE、PsycINFO、LILACS、科学引文索引和护理学与健康领域数据库），时间跨度从建库至2019年12月，无语言限制。符合条件的论文报告了使用归纳法描述从业者报告的伦理挑战的原始研究。
共筛选了8074条记录。纳入了来自九个国家的13项研究。挑战分为六个主题：伦理原则的应用；提供临床护理；与家属合作；参与机构结构和价值观；应对社会价值观和期望；姑息治疗的理念。挑战与特定场景/背景相关，而非一般伦理原则的应用，且发生在各个层面（床边、机构、社会、政策）。
姑息治疗从业者面临广泛的情境伦理挑战，其中许多在姑息治疗伦理培训资源中并未体现，例如，应对机构政策、资源分配和跨专业冲突。研究结果对支持伦理实践和培训从业者具有启示意义。低收入和中等收入国家的数据匮乏问题亟待解决。
