Wolfson Institute of Population Health, Queen Mary University of London, London, E1 4NS, UK.
School of Medicine, University of St Andrews, St Andrews, KY16 9TF, UK.
J R Soc Med. 2023 Sep;116(9):295-306. doi: 10.1177/01410768231181248. Epub 2023 Jun 8.
There has been growing concern about doctors' conflicts of interests (COIs) but it is unclear what processes and tools exist to enable the consistent declaration and management of such interests. This study mapped existing policies across a variety of organisations and settings to better understand the degree of variation and identify opportunities for improvement.
Thematic analysis.
We studied the COI policies of 31 UK and international organisations which set or influence professional standards or engage doctors in healthcare commissioning and provision settings.
31 UK and international organisations.
Organisational policy similarities and differences.
Most policies (29/31) referred to the need for individuals to apply judgement when deciding whether an interest is a conflict, with just over half (18/31) advocating a low threshold. Policies differed on the perception of frequency of COI, the timings of declarations, the type of interests that needed to be declared, and how COI and policy breaches should be managed. Just 14/31 policies stated a duty to report concerns in relation to COI. Only 18/31 policies advised COI would be published, while three stated that any disclosures would remain confidential.
The analysis of organisational policies revealed wide variation in what interests should be declared, when and how. This variation suggests that the current system may not be adequate to maintain a high level of professional integrity in all settings and that there is a need for better standardisation that reduces the risk of errors while addressing the needs of doctors, organisations and the public.
人们对医生的利益冲突（COI）越来越关注，但目前尚不清楚存在哪些流程和工具可以使利益冲突得到一致的申报和管理。本研究对各种组织和环境中的现有政策进行了映射，以更好地了解差异程度，并确定改进机会。
主题分析。
我们研究了 31 个英国和国际组织的 COI 政策，这些政策制定或影响专业标准或参与医疗保健委托和提供环境中的医生。
31 个英国和国际组织。
组织政策的相似性和差异性。
大多数政策（31/31）提到个人在决定利益是否存在冲突时需要运用判断力，只有超过一半（18/31）的政策主张低门槛。政策在 COI 的频率感知、申报时间、需要申报的利益类型以及如何管理 COI 和政策违规方面存在差异。只有 14/31 的政策规定有义务报告与 COI 相关的问题。只有 18/31 的政策建议 COI 将被公布，而有三个政策表示任何披露将保持机密。
对组织政策的分析显示，需要申报的利益、申报的时间和方式存在广泛差异。这种差异表明，目前的系统可能不足以在所有环境中保持高水平的专业诚信，需要更好的标准化，在满足医生、组织和公众需求的同时降低错误风险。
