Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.
BMC Med Ethics. 2022 Jun 30;23(1):67. doi: 10.1186/s12910-022-00803-x.
Clinical Ethics Support Services (CESS) have been established to support healthcare professionals in addressing ethically sensitive issues in clinical practice and, in many countries, they are under development. In the context of growing CESS, exploring how healthcare professionals experience and address clinical ethics issues in their daily practice represents a fundamental step to understand their potential needs. This is even more relevant in the context of extremely sensitive diseases, such as cancer. On this basis, we carried out a qualitative study conducting in-depth semi-structured interviews with stakeholders of a major comprehensive cancer centre in Italy, with the twofold aim of investigating what ethical issues arise in the context of clinical oncology and how they are addressed, as well as stakeholders' expectations about a potential CESS to be implemented within the Institution.
The study was conducted within the theoretical framework of Grounded Theory. Participants were healthcare professionals and other key stakeholders working within the cancer centre. The semi-structured interview aimed at exploring common ethical aspects of oncology, investigating stakeholders' professional experience in dealing with clinical ethics issues, their expectations and requests regarding ethics support services. Transcripts of the interviews were coded and analysed according to the principles of Grounded Theory.
Twenty-one stakeholders were interviewed. Our analysis showed a wide consensus on the identification of ethically relevant issues, above all those concerning communication, end-of-life, and resource allocation. The absence of institutional tools or strategies to address and manage ethical issues at the patient bedside emerged, and this is reflected in the widespread request for their development in the future. The ideal support service should be fast and flexible in order to adapt to different needs and clinical cases.
The interviewees showed a limited degree of 'ethical awareness': despite having reported many issues in clinical practice, they could hardly identify and describe the ethical aspects, while complaining about a lack of ethical resources in their management. To build a truly effective support service, it therefore seems appropriate to take such context into consideration and address the emerged needs. Ethical sensitivity seems to be key and it becomes even more relevant in critical clinical areas, such as the therapeutic pathways of terminally ill patients.
临床伦理支持服务（CESS）的设立旨在支持医疗保健专业人员在临床实践中解决伦理敏感问题，并且在许多国家，它们正在发展中。在 CESS 不断发展的背景下，探索医疗保健专业人员如何在日常实践中体验和解决临床伦理问题代表了理解其潜在需求的基本步骤。在癌症等极其敏感的疾病方面，这一点更为重要。在此基础上，我们对意大利一家大型综合癌症中心的利益相关者进行了一项定性研究，进行了深入的半结构化访谈，旨在调查临床肿瘤学背景下出现的伦理问题以及如何解决这些问题，以及利益相关者对可能在机构内实施的 CESS 的期望。
该研究是在扎根理论的理论框架内进行的。参与者是在癌症中心工作的医疗保健专业人员和其他主要利益相关者。半结构化访谈旨在探讨肿瘤学的常见伦理方面，调查利益相关者在处理临床伦理问题方面的专业经验，以及他们对伦理支持服务的期望和要求。根据扎根理论的原则对访谈记录进行编码和分析。
共采访了 21 位利益相关者。我们的分析表明，在确定伦理相关问题上存在广泛共识，尤其是那些涉及沟通、临终和资源分配的问题。在患者床边解决和管理伦理问题的机构工具或策略的缺失也凸显出来，这反映了他们对未来发展的广泛要求。理想的支持服务应该快速灵活，以适应不同的需求和临床病例。
受访者表现出有限的“伦理意识”：尽管在临床实践中报告了许多问题，但他们几乎无法识别和描述伦理方面，同时抱怨在管理方面缺乏伦理资源。因此，要建立一个真正有效的支持服务，似乎需要考虑到这种情况并满足所出现的需求。伦理敏感性似乎是关键，在诸如绝症患者的治疗途径等关键临床领域，这一点更为重要。
