Pergert Pernilla, Molewijk Bert, Bartholdson Cecilia
Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden.
Centre for Research Ethics & Bioethics (CRB), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
HEC Forum. 2025 Sep;37(3):345-356. doi: 10.1007/s10730-024-09541-6. Epub 2024 Nov 2.
Caring for children with cancer involves complex ethical challenges. Ethics Case Reflection (ECR) rounds can be offered to support teams to reflect on challenges and what should be done in patient care. A training course, for facilitators of ECR rounds, has been offered to healthcare professionals (HCPs) in childhood cancer care by a Nordic working group on ethics. During/after the course, the trainees implemented and facilitated ECR rounds in their clinical setting. The aim was to explore the trainees' experiences of implementing ECR rounds in childhood cancer care. HCPs, who participated as trainees in the course, participated in 3 focus group interviews (n = 22) and 27 individual interviews (n = 17). Interview data were analysed concurrently with data collection following classic grounded theory. Positioning ethics is the core category in this study, used to resolve the main concern of doing ethics in a context where direct patient care is prioritized. Being able to take time for ethics reflections, not perceived as the key priority, was considered a luxury in the clinical setting. Strategies for positioning ethics include allying, promoting ethics reflection, scheduling ethics reflection, and identifying ethical dilemmas. These strategies can be more or less successful and vary in intensity. The prioritisation of direct patient care is not surprising, but polarisation between care and ethics needs to be questioned and ethics reflection need to be integrated in standard care. Ethical competence seems to be central in doing ethics and more knowledge on the promotion of ethical competence in practice and education is needed.
照顾患有癌症的儿童涉及复杂的伦理挑战。可以开展伦理案例反思（ECR）轮次，以支持团队思考挑战以及在患者护理中应采取的措施。北欧伦理工作组为儿童癌症护理领域的医疗专业人员（HCP）提供了一门针对ECR轮次 facilitators 的培训课程。在课程期间/之后，学员们在其临床环境中实施并推动了ECR轮次。目的是探索学员们在儿童癌症护理中实施ECR轮次的经验。作为学员参加该课程的HCP参加了3次焦点小组访谈（n = 22）和27次个人访谈（n = 17）。访谈数据在收集数据的同时按照经典扎根理论进行分析。定位伦理是本研究的核心类别，用于解决在优先考虑直接患者护理的背景下进行伦理实践的主要问题。能够抽出时间进行伦理反思，在临床环境中并不被视为关键优先事项，而是被认为是一种奢侈。定位伦理的策略包括结盟、促进伦理反思、安排伦理反思时间以及识别伦理困境。这些策略的成功程度或多或少有所不同，强度也有所差异。直接患者护理的优先地位并不令人惊讶，但护理与伦理之间的两极分化需要受到质疑，并且伦理反思需要融入标准护理中。伦理能力似乎是进行伦理实践的核心，在实践和教育中需要更多关于促进伦理能力的知识。
