Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany.
BMC Med Ethics. 2023 Jul 4;24(1):46. doi: 10.1186/s12910-023-00923-y.
Similar to many other countries, in Germany patients with alcohol-related liver disease are obliged to prove their abstinence before being accepted on a waitlist for liver transplantation. Health care professionals (HCPs) must both treat patients and ensure that patients have proven their abstinence. The aim of this exploratory study was to develop a deeper understanding of how HCPs deal with this dual role.
The study used semi-structured interviews as the source of data. 11 healthcare professionals from ten of the 22 German transplant centers were interviewed. After transcription, a qualitative content analysis was performed.
We found that these HCPs faced an ethical dilemma, as they must balance the roles of being both a treatment provider (the therapist role) and an assessor (the monitoring role). To solve this dilemma, the strategy seems to be a tendency for the HCPs to take on one dominant role amongst these two roles. HCPs who prefer to take on the therapist role seem to feel burdened by the 6-month abstinence rule and the obligation to monitor their patients. HCPs who prefer to take on the monitoring role tend to have negative assumptions about the patients. HCPs also reported the impression that patients perceive HCPs as more involved in monitoring and less open to the therapeutic role. From this it can be deduced that current regulations and structures lead both to stress for HCPs and to suboptimal therapy for those affected.
The results showed that current transplantation guidelines can have a negative impact on both patient care and the burdens on the HCPs. From our point of view, there are various changes that could be made to the current clinical practice that would help solve this dilemma. For instance, integrating other assessment criteria that are more closely adapted to the health status trajectory and psychosocial background of the individual patient would be both possible and would lead to improvements in practice.
与许多其他国家一样，在德国，患有酒精相关性肝病的患者在被接受肝移植等待名单之前，必须证明自己已经戒酒。医疗保健专业人员（HCP）必须既要治疗患者，又要确保患者已经证明自己已经戒酒。这项探索性研究的目的是更深入地了解 HCP 如何应对这一双重角色。
该研究使用半结构化访谈作为数据来源。从德国 22 个移植中心中的 10 个中心采访了 11 名医疗保健专业人员。转录后，进行了定性内容分析。
我们发现，这些 HCP 面临着伦理困境，因为他们必须平衡作为治疗提供者（治疗师角色）和评估者（监测角色）的角色。为了解决这个困境，策略似乎是 HCP 倾向于在这两个角色中承担一个主要角色。那些倾向于承担治疗师角色的 HCP 似乎对 6 个月的戒酒规则和监测患者的义务感到负担过重。那些倾向于承担监测角色的 HCP 往往对患者持有负面假设。HCP 还报告说，患者认为 HCP 更多地参与监测，而对治疗角色不太开放。由此可以推断，目前的规定和结构既给 HCP 带来压力，也给受影响的人带来治疗效果不佳的问题。
结果表明，目前的移植指南可能对患者护理和 HCP 的负担产生负面影响。从我们的角度来看，目前的临床实践可以进行各种改变，以帮助解决这一困境。例如，整合其他更紧密适应个体患者健康状况轨迹和社会心理背景的评估标准是可能的，并将导致实践的改进。
