Weiner Charlotte, Pergert Pernilla, Molewijk Bert, Castor Anders, Bartholdson Cecilia
Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Paediatric Regional Health Care, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
BMC Med Ethics. 2021 Mar 17;22(1):27. doi: 10.1186/s12910-021-00597-4.
In childhood cancer care, healthcare professionals must deal with several difficult moral situations in clinical practice. Previous studies show that morally difficult challenges are related to decisions on treatment limitations, infringing on the child's integrity and growing autonomy, and interprofessional conflicts. Research also shows that healthcare professionals have expressed a need for clinical ethics support to help them deal with morally difficult situations. Moral case deliberations (MCDs) are one example of ethics support. The aim of this study was to describe the MCD-related outcomes that healthcare professionals in childhood cancer care considered important, before MCDs were implemented, in order to facilitate the implementation of MCDs in childhood cancer care in Sweden.
This study is based on qualitative data. Healthcare professionals, mostly representing registered nurses, nursing assistants and physicians, working at childhood cancer care centres in Sweden, were invited to respond to the translated and content validated European MCD Outcomes Instrument, before participating in regular MCDs. Answers to the main open-ended question, included in the questionnaire, was analysed according to systematic text condensation.
Data was collected from 161 responses from the healthcare professionals. The responses included healthcare professionals' perceptions of which MCD-related outcomes they found important for handling moral challenges. Three different themes of important outcomes from the analysis of the data are presented as follows: Interprofessional well-being in team interactions on a team level; Professional comfort when dealing with moral challenges on a personal level; and Improved quality of care for the child and the family on a care level.
Healthcare professionals in childhood cancer care considered it important that ethics support could enhance the well-being of interprofessional teams, support healthcare professionals on an individual level and improve quality of care. The results of this study can be used in current and future training for MCD-facilitators. When knowing the context specific important MCD-outcomes, the sessions could be adapted. Managers in childhood cancer care would benefit from knowing about the specific important outcomes for their target group because they could then create relevant working conditions for clinical ethics support.
在儿童癌症护理中，医疗保健专业人员在临床实践中必须应对若干棘手的道德困境。以往研究表明，道德困境挑战与治疗限制决策、侵犯儿童的完整性和日益增长的自主权以及跨专业冲突有关。研究还表明，医疗保健专业人员表示需要临床伦理支持来帮助他们应对道德困境。道德案例审议（MCDs）是伦理支持的一个例子。本研究的目的是描述在瑞典儿童癌症护理中实施MCDs之前，儿童癌症护理领域的医疗保健专业人员认为重要的与MCD相关的结果，以便促进MCDs在瑞典儿童癌症护理中的实施。
本研究基于定性数据。邀请了主要代表注册护士、护理助理和医生的瑞典儿童癌症护理中心的医疗保健专业人员，在参加常规MCDs之前，对翻译并经内容验证的欧洲MCD结果工具做出回应。根据系统文本浓缩法对问卷中包含的主要开放式问题的答案进行分析。
收集了来自医疗保健专业人员的161份回复数据。这些回复包括医疗保健专业人员对他们认为哪些与MCD相关的结果对于应对道德挑战很重要的看法。对数据进行分析后得出的三个不同的重要结果主题如下：团队层面团队互动中的跨专业幸福感；个人层面应对道德挑战时的职业舒适度；护理层面改善对儿童及其家庭的护理质量。
儿童癌症护理领域的医疗保健专业人员认为，伦理支持能够提高跨专业团队的幸福感、在个人层面支持医疗保健专业人员并改善护理质量，这很重要。本研究结果可用于当前和未来对MCD促进者的培训。当了解特定背景下重要的MCD结果时，会议可以进行调整。儿童癌症护理机构的管理人员若了解其目标群体的特定重要结果将受益，因为这样他们可以为临床伦理支持创造相关的工作条件。
