Perceptions of important outcomes of moral case deliberations: a qualitative study among healthcare professionals in childhood cancer care.
Childhood cancer care
Clinical ethics
Clinical ethics support
Healthcare professionals
Moral case deliberations
Moral challanges
Outcomes
Qualitative
Journal
BMC medical ethics
ISSN: 1472-6939
Titre abrégé: BMC Med Ethics
Pays: England
ID NLM: 101088680
Informations de publication
Date de publication:
17 03 2021
17 03 2021
Historique:
received:
21
04
2020
accepted:
04
03
2021
entrez:
18
3
2021
pubmed:
19
3
2021
medline:
29
7
2021
Statut:
epublish
Résumé
In childhood cancer care, healthcare professionals must deal with several difficult moral situations in clinical practice. Previous studies show that morally difficult challenges are related to decisions on treatment limitations, infringing on the child's integrity and growing autonomy, and interprofessional conflicts. Research also shows that healthcare professionals have expressed a need for clinical ethics support to help them deal with morally difficult situations. Moral case deliberations (MCDs) are one example of ethics support. The aim of this study was to describe the MCD-related outcomes that healthcare professionals in childhood cancer care considered important, before MCDs were implemented, in order to facilitate the implementation of MCDs in childhood cancer care in Sweden. This study is based on qualitative data. Healthcare professionals, mostly representing registered nurses, nursing assistants and physicians, working at childhood cancer care centres in Sweden, were invited to respond to the translated and content validated European MCD Outcomes Instrument, before participating in regular MCDs. Answers to the main open-ended question, included in the questionnaire, was analysed according to systematic text condensation. Data was collected from 161 responses from the healthcare professionals. The responses included healthcare professionals' perceptions of which MCD-related outcomes they found important for handling moral challenges. Three different themes of important outcomes from the analysis of the data are presented as follows: Interprofessional well-being in team interactions on a team level; Professional comfort when dealing with moral challenges on a personal level; and Improved quality of care for the child and the family on a care level. Healthcare professionals in childhood cancer care considered it important that ethics support could enhance the well-being of interprofessional teams, support healthcare professionals on an individual level and improve quality of care. The results of this study can be used in current and future training for MCD-facilitators. When knowing the context specific important MCD-outcomes, the sessions could be adapted. Managers in childhood cancer care would benefit from knowing about the specific important outcomes for their target group because they could then create relevant working conditions for clinical ethics support.
Sections du résumé
BACKGROUND
In childhood cancer care, healthcare professionals must deal with several difficult moral situations in clinical practice. Previous studies show that morally difficult challenges are related to decisions on treatment limitations, infringing on the child's integrity and growing autonomy, and interprofessional conflicts. Research also shows that healthcare professionals have expressed a need for clinical ethics support to help them deal with morally difficult situations. Moral case deliberations (MCDs) are one example of ethics support. The aim of this study was to describe the MCD-related outcomes that healthcare professionals in childhood cancer care considered important, before MCDs were implemented, in order to facilitate the implementation of MCDs in childhood cancer care in Sweden.
METHODS
This study is based on qualitative data. Healthcare professionals, mostly representing registered nurses, nursing assistants and physicians, working at childhood cancer care centres in Sweden, were invited to respond to the translated and content validated European MCD Outcomes Instrument, before participating in regular MCDs. Answers to the main open-ended question, included in the questionnaire, was analysed according to systematic text condensation.
RESULTS
Data was collected from 161 responses from the healthcare professionals. The responses included healthcare professionals' perceptions of which MCD-related outcomes they found important for handling moral challenges. Three different themes of important outcomes from the analysis of the data are presented as follows: Interprofessional well-being in team interactions on a team level; Professional comfort when dealing with moral challenges on a personal level; and Improved quality of care for the child and the family on a care level.
CONCLUSIONS
Healthcare professionals in childhood cancer care considered it important that ethics support could enhance the well-being of interprofessional teams, support healthcare professionals on an individual level and improve quality of care. The results of this study can be used in current and future training for MCD-facilitators. When knowing the context specific important MCD-outcomes, the sessions could be adapted. Managers in childhood cancer care would benefit from knowing about the specific important outcomes for their target group because they could then create relevant working conditions for clinical ethics support.
Identifiants
pubmed: 33731101
doi: 10.1186/s12910-021-00597-4
pii: 10.1186/s12910-021-00597-4
pmc: PMC7970765
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
27Subventions
Organisme : Barncancerfonden
ID : PR2016-0020
Organisme : Barncancerfonden
ID : TJ2017-0011
Organisme : Stockholms Läns Landsting
ID : LS 2018-0792
Références
Medsurg Nurs. 2007 Apr;16(2):131-3
pubmed: 17547273
Health Care Anal. 2013 Dec;21(4):323-37
pubmed: 21912993
Nurs Sci Q. 2004 Jan;17(1):86-91
pubmed: 14752958
Nurs Ethics. 2018 Feb;25(1):6-19
pubmed: 27098415
HEC Forum. 2015 Mar;27(1):47-59
pubmed: 25218568
Lancet. 2001 Aug 4;358(9279):397-400
pubmed: 11502338
Sci Eng Ethics. 2015 Dec;21(6):1525-35
pubmed: 25388547
AACN Adv Crit Care. 2015 Apr-Jun;26(2):142-50
pubmed: 25898882
Bioethics. 2017 May;31(4):246-257
pubmed: 28417518
Cancer Nurs. 2015 Mar-Apr;38(2):125-32
pubmed: 24945260
Scand J Caring Sci. 2012 Sep;26(3):427-35
pubmed: 22070455
Psychooncology. 2016 Sep;25(9):1036-42
pubmed: 26677126
J Clin Nurs. 2016 Nov;25(21-22):3252-3260
pubmed: 27524314
BMC Med Ethics. 2018 Nov 6;19(1):85
pubmed: 30400913
Bioethics. 2011 May;25(4):220-7
pubmed: 19860746
J Med Ethics. 2013 Nov;39(11):681-5
pubmed: 23328983
J Med Ethics. 2005 May;31(5):256-61
pubmed: 15863679
J Med Ethics. 2019 Sep;45(9):608-616
pubmed: 31320403
Nurs Ethics. 2012 Mar;19(2):183-95
pubmed: 22457383
Am J Nurs. 2017 Feb;117(2 Suppl 1):S11-S15
pubmed: 28085701
BMC Med Ethics. 2014 Apr 08;15:30
pubmed: 24712735
J Med Ethics. 2008 Feb;34(2):120-4
pubmed: 18234952
Nurs Ethics. 2017 Dec;24(8):878-891
pubmed: 27005953
Med Health Care Philos. 2008 Mar;11(1):43-56
pubmed: 18165908
Am J Bioeth. 2015;15(5):3-17
pubmed: 25970382
Online J Issues Nurs. 2011 Mar 21;16(2):8
pubmed: 22088157
Educ Health (Abingdon). 2015 Jan-Apr;28(1):52-7
pubmed: 26261115
Nurs Ethics. 2016 Mar;23(2):203-13
pubmed: 25527354
Nurs Ethics. 2016 Jun;23(4):421-31
pubmed: 25736273
Nurs Ethics. 2019 Nov-Dec;26(7-8):2351-2363
pubmed: 30411660
J Clin Oncol. 2006 Jan 1;24(1):160-5
pubmed: 16382126
BMC Med Ethics. 2017 Feb 20;18(1):14
pubmed: 28219363
J Med Ethics. 2016 Sep;42(9):586-91
pubmed: 27317508
Scand J Public Health. 2012 Dec;40(8):795-805
pubmed: 23221918
J Nurs Scholarsh. 2015 May;47(3):275-84
pubmed: 25801466
J Child Health Care. 2011 Jun;15(2):99-106
pubmed: 21685225
Cancer Treat Res. 2000;102:99-135
pubmed: 10650484
Nurs Ethics. 2018 Mar;25(2):199-211
pubmed: 29529973
Science. 2019 Mar 15;363(6432):1182-1186
pubmed: 30872518
J Med Ethics. 2018 Jan;44(1):13-20
pubmed: 28751469