Al-Bakri Amal G, Akour Amal A, Al-Delaimy Wael K
School of Pharmacy, Department of Pharmaceutics and Pharmaceutical Technology, The University of Jordan, Amman, 11942, Jordan.
School of Pharmacy, Department of Biopharmaceutics and Clinical Pharmacy, The University of Jordan, Amman, 11942, Jordan.
BMC Med Ethics. 2021 Feb 27;22(1):19. doi: 10.1186/s12910-021-00587-6.
Fecal microbiota transplant (FMT) is a treatment modality that involves the introduction of stool from a healthy pre-screened donor into the gastrointestinal tract of a patient. It exerts its therapeutic effects by remodeling the gut microbiota and treating microbial dysbiosis-imbalance. FMT is not regulated in Jordan, and regulatory effort for FMT therapy in Jordan, an Islamic conservative country, might be faced with unique cultural, social, religious, and ethical challenges. We aimed to assess knowledge, attitudes, and perceptions of ethical and social issues of FMT use among Jordanian healthcare professionals.
An observational, cross-sectional study design was used to assess knowledge, attitudes, and perceptions of ethical and social issues of FMT among 300 Jordanian healthcare professionals.
A large proportion (39 %) thought that the safety and efficacy of this technique are limited and 29.3 % thought there is no evidence to support its use. Almost all (95 %) responded that they would only perform it in certain cases, if ethically justified, and 48.3 % would use it due to treatment failure of other approaches. When reporting about reasons for not using it, 40 % reported that they would not perform it due to concerns about medical litigation, fear of infections (38 %), and lack of knowledge of long safety and efficacy (31.3 %). Interestingly, all practitioners said they would perform this procedure through the lower rather than upper gastrointestinal tract modality and the majority will protect the patient's confidentiality via double-blinding (43.3 %). For a subset of participants (n = 100), the cultural constraints that might affect the choice of performing FMT were mainly due to donor's religion, followed by dietary intake, and alcohol consumption.
Our healthcare practitioners are generally reluctant to use the FMT modality due to religious and ethical reasons but would consider it if there was a failure of other treatment and after taking into consideration many legislative, social, ethical and practice-based challenges including safety, efficacy and absence of guidelines.
粪便微生物群移植（FMT）是一种治疗方式，涉及将经过预先筛选的健康供体的粪便引入患者的胃肠道。它通过重塑肠道微生物群和治疗微生物失调（失衡）来发挥治疗作用。FMT在约旦不受监管，在约旦这个伊斯兰保守国家，对FMT疗法的监管工作可能面临独特的文化、社会、宗教和伦理挑战。我们旨在评估约旦医疗保健专业人员对FMT使用的伦理和社会问题的知识、态度和看法。
采用观察性横断面研究设计，评估300名约旦医疗保健专业人员对FMT伦理和社会问题的知识、态度和看法。
很大一部分人（39%）认为该技术的安全性和有效性有限，29.3%的人认为没有证据支持其使用。几乎所有人（95%）回答说，只有在符合伦理的情况下，他们才会在某些情况下进行该操作，48.3%的人会因为其他方法治疗失败而使用它。在报告不使用它的原因时，40%的人报告说，由于担心医疗诉讼、害怕感染（38%）以及缺乏长期安全性和有效性的知识（31.3%），他们不会进行该操作。有趣的是，所有从业者都表示他们将通过下消化道而非上消化道方式进行此操作，并且大多数人将通过双盲保护患者的隐私（43.3%）。对于一部分参与者（n = 100），可能影响进行FMT选择的文化限制主要是由于供体的宗教信仰，其次是饮食摄入和饮酒。
我们的医疗保健从业者通常因宗教和伦理原因不愿使用FMT方式，但如果其他治疗失败并且在考虑了许多包括安全性、有效性和缺乏指南在内的立法、社会、伦理和基于实践的挑战后，会考虑使用它。
