Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden; Children Regional Health Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden; Paediatric Haematology and Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
Eur J Oncol Nurs. 2022 Oct;60:102189. doi: 10.1016/j.ejon.2022.102189. Epub 2022 Aug 13.
To describe performed moral case deliberations and present a nationwide study of difficult situations and moral questions raised by healthcare professionals during moral case deliberations in Swedish childhood cancer care.
Written reports (n = 72) about difficult situations and moral questions were completed by healthcare professionals, trained as facilitators, who implemented moral case deliberations at all paediatric oncology centres in Sweden. A qualitative systematic text condensation was used for data analysis.
A pattern of biopsychosocial factors was found in the difficult situations, including medical, psycho-social, and religious/cultural information. Three different themes of moral questions emerged. The first, "What is the limit of healthcare professionals' responsibilities?", included whether, and to what degree, healthcare professionals should depart from professional values, and whether/when to interfere with parents' choices in care. The second theme, "Who has a mandate to decide on care?", covered conflicting perspectives on care related to decision making. The third theme, "What is the right care action to take?", concerned the best interest of the child and moral questions about whether the chosen care action would promote a better or worse outcome.
This study contributes to increased understanding of difficult situations and moral questions raised during moral case deliberations in Swedish childhood cancer care. Biopsychosocial factors are important to take into account in order to achieve a holistic view of the situation. Although several moral questions concerned medical treatment and life and death, others were related to everyday clinical practice and the differing perspectives of children, parents, and healthcare professionals.
描述已进行的道德案例审议，并呈现一项全国性研究，该研究关注瑞典儿童癌症护理中医疗保健专业人员在道德案例审议中提出的困难情况和道德问题。
由经过培训的医疗保健专业人员作为促进者，在瑞典所有儿科肿瘤中心实施道德案例审议后，完成关于困难情况和道德问题的书面报告（n=72）。采用定性系统文本浓缩法进行数据分析。
在困难情况下发现了生物心理社会因素模式，包括医疗、心理社会和宗教/文化信息。出现了三个不同主题的道德问题。第一个主题是“医疗保健专业人员的责任界限是什么？”，包括医疗保健专业人员是否应该背离专业价值观，以及在何种程度上应该背离，以及是否/何时干预父母对护理的选择。第二个主题是“谁有权决定护理？”，涉及与决策相关的护理的冲突观点。第三个主题是“采取何种正确的护理行动？”，涉及儿童的最佳利益以及关于所选择的护理行动是否会促进更好或更糟糕结果的道德问题。
本研究有助于增加对瑞典儿童癌症护理中道德案例审议中提出的困难情况和道德问题的理解。为了全面了解情况，生物心理社会因素是需要考虑的重要因素。尽管一些道德问题涉及医疗和生死，但其他问题则与日常临床实践以及儿童、父母和医疗保健专业人员的不同观点有关。
