Pahwa Manisha, Abelson Julia, Demers Paul A, Schwartz Lisa, Shen Katrina, Vanstone Meredith
Health Policy PhD Program, McMaster University, Hamilton, Ontario, Canada.
Occupational Cancer Research Centre, Cancer Care Ontario, Ontario Health, Toronto, Ontario, Canada.
Public Health Ethics. 2024 Aug 29;17(3):139-153. doi: 10.1093/phe/phae008. eCollection 2024 Nov.
Normative issues associated with the design and implementation of population-based lung cancer screening policies are underexamined. This study was an exposition of the ethical justification for screening and potential ethical issues and their solutions in Canadian jurisdictions. A qualitative description study was conducted. Key informants, defined as policymakers, scientists and clinicians who develop and implement lung cancer screening policies in Canada, were purposively sampled and interviewed using a semi-structured guide informed by population-based disease screening principles and ethical issues in cancer screening. Interview data were analyzed using qualitative content analysis. Fifteen key informants from seven provinces were interviewed. Virtually all justified screening by beneficence, describing that population benefits outweigh individual harms if high-risk people are screened in organized programs according to disease screening principles. Equity of screening access, stigma and lung cancer primary prevention were other ethical issues identified. Key informants prioritized beneficence over concerns for group-level justice issues when making decisions about whether to implement screening policies. This prioritization, though slight, may impede the implementation of screening policies in a way that effectively addresses justice issues, a goal likely to require justice theory and critical interpretation of disease screening principles.
与基于人群的肺癌筛查政策的设计和实施相关的规范性问题尚未得到充分研究。本研究阐述了加拿大各辖区筛查的伦理依据、潜在的伦理问题及其解决方案。开展了一项定性描述研究。关键信息提供者被定义为在加拿大制定和实施肺癌筛查政策的政策制定者、科学家和临床医生，采用基于人群的疾病筛查原则和癌症筛查伦理问题设计的半结构化指南，有目的地抽取样本并进行访谈。使用定性内容分析法对访谈数据进行分析。来自七个省份的15名关键信息提供者接受了访谈。几乎所有人都以行善原则为筛查辩护，称如果按照疾病筛查原则在有组织的项目中对高危人群进行筛查，人群受益将超过个体伤害。筛查可及性的公平性、污名化和肺癌一级预防是识别出的其他伦理问题。在决定是否实施筛查政策时，关键信息提供者将行善置于对群体层面正义问题的关注之上。这种优先排序虽然细微，但可能会以一种有效解决正义问题的方式阻碍筛查政策的实施，而这一目标可能需要正义理论和对疾病筛查原则的批判性解读。
