Ethics case reflection sessions: Enablers and barriers

2017 ◽  
Vol 25 (2) ◽  
pp. 199-211 ◽  
Author(s):  
Cecilia Bartholdson ◽  
Bert Molewijk ◽  
Kim Lützén ◽  
Klas Blomgren ◽  
Pernilla Pergert
Keyword(s):  
Childhood Cancer ◽  
Cancer Care ◽  
Healthcare Professionals ◽  
Ethical Review ◽  
Main Concern ◽  
Ethical Considerations ◽  
New Knowledge ◽  
Ethical Skills ◽  
Professional Perspectives

Background: In previous research on ethics case reflection (ECR) sessions about specific cases, healthcare professionals in childhood cancer care were clarifying their perspectives on the ethical issue to resolve their main concern of consolidating care. When perspectives were clarified, consequences in the team included ‘increased understanding’, ‘group strengthening’ and ‘decision grounding’. Additional analysis of the data was needed on conditions that could contribute to the quality of ECR sessions. Objective: The aim of this study was to explore conditions for clarifying perspectives during ECR sessions. Research design: Data were collected from observations and interviews and the results emerged from an inductive analysis using grounded theory. Participants and research context: Six observations during ECR sessions and 10 interviews were performed with healthcare professionals working in childhood cancer care and advanced paediatric homecare. Ethical considerations: The study was approved by a regional ethical review board. Participants were informed about their voluntary involvement and that they could withdraw their participation without explaining why. Findings: Two categories emerged: organizational enablers and barriers and team-related enablers and barriers. Organizational enablers and barriers included the following sub-categories: the timing of the ECR session, the structure during the ECR session and the climate during the ECR session. Sub-categories to team-related enablers and barriers were identified as space for inter-professional perspectives, varying levels of ethical skills and space for the patient’s and the family’s perspectives. Discussion: Space for inter-professional perspectives included the dominance of a particular perspective that can result from hierarchical positions. The medical perspective is relevant for understanding the child’s situation but should not dominate the ethical reflection. Conclusion: Conditions for ECR sessions have been explored and the new knowledge can be used when training facilitators as well as for those who organize/implement ECR sessions. Awareness of space for different perspectives, including the possible medical advantage over the nursing perspective, could reduce the somewhat unilateral attention and contribute to an inter-professionally shared reflection.

scholarly journals Perceptions of important outcomes of moral case deliberations: a qualitative study among healthcare professionals in childhood cancer care

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Charlotte Weiner ◽  
Pernilla Pergert ◽  
Bert Molewijk ◽  
Anders Castor ◽  
Cecilia Bartholdson
Keyword(s):  
Quality Of Care ◽  
Childhood Cancer ◽  
Clinical Ethics ◽  
Cancer Care ◽  
Healthcare Professionals ◽  
Well Being ◽  
Clinical Ethics Support ◽  
Ethics Support ◽  
Moral Case

Abstract 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.

scholarly journals Perceptions of Important Outcomes of Ethics Case Reflection Rounds: A Qualitative Study among Healthcare Professionals in Childhood Cancer Care

2020 ◽  
Author(s):  
Charlotte Weiner ◽  
Pernilla Pergert ◽  
Bert Molewijk ◽  
Anders Castor ◽  
Cecilia Bartholdson
Keyword(s):  
Quality Of Care ◽  
Childhood Cancer ◽  
Cancer Care ◽  
Healthcare Professionals ◽  
Well Being ◽  
Moral Case Deliberation ◽  
Individual Level ◽  
Ethics Support ◽  
Moral Case

Abstract BACKGROUND: In childhood cancer care, healthcare professionals mustdeal 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 want ethics support to help them deal with morally difficult situations.Ethics case reflection (ECR)roundsare one example of ethics support. However, there is little research intohealthcare professionals’ perceptions of important outcomes prior to participation in ethics case reflectionrounds in childhood cancer care. The aim was to explorehealthcare professionals’ perceptions of outcomes of ECR rounds important for handling moral challenges prior to participation in ECR rounds in childhood cancer care.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 Moral Case Deliberation questionnaire,before participating in regular ECR rounds. 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 who were invited to participate. The responses included healthcare professionals’ perceptions of which ethics case reflection round-related outcomes they found important for handling moral challenges. Three different themes of important outcomes emerged from the analysis of the data: Inter-professional wellbeing, Being in a professional comfort zone, and Improved quality of care. The themes are related to teams, individuals and care, respectively.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. To realize these perceived important outcomes, conditions for ECR rounds need to be improved. The results of this study can be used in future training for facilitators of ECR rounds, as well as providing information to healthcare managers wishing to implement this kind of ethics support.

scholarly journals Perceptions of important outcomes of moral case deliberations: a qualitative study among healthcare professionals in childhood cancer care

2020 ◽  
Author(s):  
Charlotte Weiner ◽  
Pernilla Pergert ◽  
Bert Molewijk ◽  
Anders Castor ◽  
Cecilia Bartholdson
Keyword(s):  
Quality Of Care ◽  
Childhood Cancer ◽  
Cancer Care ◽  
Healthcare Professionals ◽  
Well Being ◽  
Moral Case Deliberation ◽  
Individual Level ◽  
Ethics Support ◽  
Moral Case

Abstract 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 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 HCPs 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 Moral Case Deliberation Outcomes Instrument, before participating in regular MCDs. 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 who were invited to participate. 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 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 tailor the conditions.

Clarifying perspectives

2015 ◽  
Vol 23 (4) ◽  
pp. 421-431 ◽  
Author(s):  
Cecilia Bartholdson ◽  
Kim Lützén ◽  
Klas Blomgren ◽  
Pernilla Pergert
Keyword(s):  
Childhood Cancer ◽  
Cancer Care ◽  
Healthcare Professionals ◽  
Ethical Issues ◽  
Pediatric Care ◽  
Ethical Review ◽  
Ethical Concerns ◽  
Making Sense ◽  
Care Approach ◽  
The Common

Background: Childhood cancer care involves many ethical concerns. Deciding on treatment levels and providing care that infringes on the child’s growing autonomy are known ethical concerns that involve the whole professional team around the child’s care. Objectives: The purpose of this study was to explore healthcare professionals’ experiences of participating in ethics case reflection sessions in childhood cancer care. Research design: Data collection by observations, individual interviews, and individual encounters. Data analysis were conducted following grounded theory methodology. Participants and research context: Healthcare professionals working at a publicly funded children’s hospital in Sweden participated in ethics case reflection sessions in which ethical issues concerning clinical cases were reflected on. Ethical considerations: The children’s and their parents’ integrity was preserved through measures taken to protect patient identity during ethics case reflection sessions. The study was approved by a regional ethical review board. Findings: Consolidating care by clarifying perspectives emerged. Consolidating care entails striving for common care goals and creating a shared view of care and the ethical concern in the specific case. The inter-professional perspectives on the ethical aspects of care are clarified by the participants’ articulated views on the case. Different approaches for deliberating ethics are used during the sessions including raising values and making sense, leading to unifying interactions. Discussion: The findings indicate that ethical concerns could be eased by implementing ethics case reflection sessions. Conflicting perspectives can be turned into unifying interactions in the healthcare professional team with the common aim to achieve good pediatric care. Conclusion: Ethics case reflection sessions is valuable as it permits the discussion of values in healthcare-related issues in childhood cancer care. Clarifying perspectives, on the ethical concerns, enables healthcare professionals to reflect on the most reasonable and ethically defensible care for the child. A consolidated care approach would be valuable for both the child and the healthcare professionals because of the common care goals.

scholarly journals Perceptions of important outcomes of moral case deliberations: a qualitative study among healthcare professionals in childhood cancer care

2020 ◽  
Author(s):  
Charlotte Weiner ◽  
Pernilla Pergert ◽  
Bert Molewijk ◽  
Anders Castor ◽  
Cecilia Bartholdson
Keyword(s):  
Quality Of Care ◽  
Childhood Cancer ◽  
Cancer Care ◽  
Healthcare Professionals ◽  
Well Being ◽  
Moral Case Deliberation ◽  
Individual Level ◽  
Ethics Support ◽  
Moral Case

Abstract 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 want 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 MCD related outcomes that HCPs in childhood cancer care considered important to achieve, before MCDs were implemented, in order to support them in handling moral challenges in every day clinical practice.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 Moral Case Deliberation questionnaire, before participating in regular MCDs. 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 who were invited to participate. 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: Inter-professional wellbeing, Being in a professional comfort zone, and Improved quality of care. The themes are related to teams, individuals and care, respectively.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 for information in 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 tailor the conditions. Finally, this study contributes to the reflection upon and evaluation of appropriate CESS outcomes in general.

scholarly journals Protecting Family Interests: An Interview Study with Foreign-Born Parents Struggling On in Childhood Cancer Care

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Pernilla Pergert ◽  
Solvig Ekblad ◽  
Olle Björk ◽  
Karin Enskär ◽  
Tom Andrews
Keyword(s):  
Childhood Cancer ◽  
Cancer Care ◽  
Main Concern ◽  
Theory Approach ◽  
Foreign Born ◽  
Healthcare Staff ◽  
Holistic View ◽  
Classic Grounded Theory ◽  
The Common ◽  
Grounded Theory Approach

Sweden's population is gradually changing to become more multiethnic and diverse and that applies also for recipients of health care, including childhood cancer care. A holistic view on the sick child in the context of its family has always been a cornerstone in childhood cancer care in Sweden. The purpose of this study was to gain knowledge about the experiences and main concern of foreign-born parents in the context of paediatric cancer care. Interviews were performed with eleven foreign-born parents and data were analysed using a classic grounded theory approach. Foreign-born parents often feel in a position of powerless dependence, but family interests are protected in their approaches to interaction with healthcare staff, through cooperation, contesting, and reluctant resigning. Healthcare staff need to listen to foreign-born parents and deal with their concerns seriously to prevent powerless-dependence and work for trustful cooperation in the common fight against childhood cancer.

Communicating about sexuality in cancer care

2017 ◽  
Author(s):  
John W. Robinson ◽  
Joshua J. Lounsberry ◽  
Lauren M. Walker
Keyword(s):  
Quality Of Life ◽  
Sexual Functioning ◽  
Cancer Care ◽  
Information Needs ◽  
Healthcare Professionals ◽  
Intervention Models ◽  
Life Issues ◽  
Sexual Concerns ◽  
Plissit Model

Extensive research has shown that cancer, and the treatment thereof, can interfere with healthy sexual functioning. Indeed, sexual dysfunction is frequently cited as one of the top adverse effects of cancer treatment. However, while healthcare professionals routinely discuss quality-of-life issues with cancer patients, the literature suggest that too often this does not include an assessment of sexual concerns. This chapter explains how the responsibility to initiate discussion on sexuality rests with the healthcare professional. Establishing the sexuality information needs of the cancer patient can sometimes be difficult and it becomes more so when healthcare professionals make erroneous assumptions concerning sexuality. Whether or not to assess sexuality is no longer a question, it must be a routine part of cancer care. While there are several different intervention models for patients suffering from sexual difficulties, the PLISSIT model is frequently used in cancer centres and easily adapted to various types of practice.

scholarly journals Measuring the Quality of a Childhood Cancer Care Delivery System: Assessing Stakeholder Agreement

2013 ◽  
Vol 16 (4) ◽  
pp. 639-646 ◽  
Author(s):  
Nicole M.E. Bradley ◽  
Paula D. Robinson ◽  
Mark L. Greenberg ◽  
Ronald D. Barr ◽  
Anne F. Klassen ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Delivery System ◽  
Cancer Care ◽  
Care Delivery

Is audit research? The relationships between clinical audit and social research

2005 ◽  
Vol 18 (4) ◽  
pp. 289-299 ◽  
Author(s):  
Rhidian Hughes
Keyword(s):  
Health Care ◽  
Social Research ◽  
Clinical Audit ◽  
Ethical Review ◽  
Audit Process ◽  
Ethical Considerations ◽  
Content Type ◽  
Multidisciplinary Working ◽  
Asking Questions

PurposeQuality has an established history in health care. Audit, as a means of quality assessment, is well understood and the existing literature has identified links between audit and research processes. This paper reviews the relationships between audit and research processes, highlighting how audit can be improved through the principles and practice of social research.Design/methodology/approachThe review begins by defining the audit process. It goes on to explore salient relationships between clinical audit and research, grouped into the following broad themes: ethical considerations, highlighting responsibilities towards others and the need for ethical review for audit; asking questions and using appropriate methods, emphasising transparency in audit methods; conceptual issues, including identifying problematic concepts, such as “satisfaction”, and the importance of reflexivity within audit; emphasising research in context, highlighting the benefits of vignettes and action research; complementary methods, demonstrating improvements for the quality of findings; and training and multidisciplinary working, suggesting the need for closer relationships between researchers and clinical practitioners.FindingsAudit processes cannot be considered research. Both audit and research processes serve distinct purposes.Originality/valueAttention to the principles of research when conducting audit are necessary to improve the quality of audit and, in turn, the quality of health care.

scholarly journals Measuring the Quality of a Childhood Cancer Care Delivery System: Quality Indicator Development

2013 ◽  
Vol 16 (4) ◽  
pp. 647-654 ◽  
Author(s):  
Nicole M.E. Bradley ◽  
Paula D. Robinson ◽  
Mark L. Greenberg ◽  
Ronald D. Barr ◽  
Anne F. Klassen ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Delivery System ◽  
Cancer Care ◽  
Quality Indicator ◽  
Care Delivery ◽  
System Quality ◽  
Indicator Development
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