Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany.
Center for Evidence-Based Healthcare, Medical Faculty and University Hospital Carl Gustav Carus , TUD Dresden University of Technology, Dresden, Germany.
J Cancer Res Clin Oncol. 2024 Jul 15;150(7):352. doi: 10.1007/s00432-024-05863-7.
Cancer care in Germany during the COVID-19 pandemic was affected by resource scarcity and the necessity to prioritize medical measures. This study explores ethical criteria for prioritization and their application in cancer practices from the perspective of German oncologists and other experts.
We conducted fourteen semi-structured interviews with German oncologists between February and July 2021 and fed findings of interviews and additional data on prioritizing cancer care into four structured group discussions, in January and February 2022, with 22 experts from medicine, nursing, law, ethics, health services research and health insurance. Interviews and group discussions were digitally recorded, transcribed verbatim and analyzed using qualitative content analysis.
Narratives of the participants focus on "urgency" as most acceptable criterion for prioritization in cancer care. Patients who are considered curable and those with a high level of suffering, were given a high degree of "urgency." However, further analysis indicates that the "urgency" criterion needs to be further distinguished according to at least three different dimensions: "urgency" to (1) prevent imminent harm to life, (2) prevent future harm to life and (3) alleviate suffering. In addition, "urgency" is modulated by the "success," which can be reached by means of an intervention, and the "likelihood" of reaching that success.
Our analysis indicates that while "urgency" is a well-established criterion, its operationalization in the context of oncology is challenging. We argue that combined conceptual and clinical analyses are necessary for a sound application of the "urgency" criterion to prioritization in cancer care.
在 COVID-19 大流行期间，德国的癌症护理受到资源短缺和优先考虑医疗措施的必要性的影响。本研究从德国肿瘤学家和其他专家的角度探讨了优先排序的伦理标准及其在癌症实践中的应用。
我们在 2021 年 2 月至 7 月期间对德国肿瘤学家进行了 14 次半结构化访谈，并将访谈结果和有关癌症护理优先排序的其他数据纳入 2022 年 1 月和 2 月进行的 4 次结构分组讨论中，讨论对象是来自医学、护理、法律、伦理、卫生服务研究和健康保险领域的 22 名专家。访谈和小组讨论均进行了数字录音、逐字转录，并使用定性内容分析进行了分析。
参与者的叙述重点是“紧迫性”，这是癌症护理中最可接受的优先排序标准。被认为可治愈和承受高痛苦的患者被赋予了高度的“紧迫性”。然而，进一步的分析表明，“紧迫性”标准需要根据至少三个不同的维度进一步区分：（1）预防即将发生的生命危害，（2）预防未来的生命危害和（3）减轻痛苦。此外，“紧迫性”还受到“成功”的调节，成功可以通过干预来实现，并且可以达到成功的“可能性”。
我们的分析表明，虽然“紧迫性”是一个既定的标准，但在肿瘤学背景下对其进行操作具有挑战性。我们认为，对于将“紧迫性”标准应用于癌症护理中的优先排序，需要进行概念和临床相结合的分析。
