RESUMO
Consumer involvement in clinical research is an essential component of a comprehensive response during emergent health challenges. During the COVID-19 pandemic, the moderation of research policies and regulation to facilitate research may raise ethical issues. Meaningful, diverse consumer involvement can help to identify practical approaches to prioritize, design, and conduct rapidly developed clinical research amid current events. Consumer involvement might also elucidate the acceptability of flexible ethics review approaches that aim to protect participants whilst being sensitive to the challenging context in which research is taking place. This article describes the main ethical challenges arising from pandemic research and how involving consumers and the community could enable resolution of such issues.
Assuntos
COVID-19 , Participação da Comunidade , Ética em Pesquisa , Humanos , Pandemias , SARS-CoV-2RESUMO
BACKGROUND: In Australia, some anti-cancer drugs are only available at significant financial cost to patients. We sought the views and practices of Australian medical oncologists regarding discussion of high cost drugs (HCDs). PARTICIPANTS AND METHODS: A postal survey was mailed to all 274 members of the Medical Oncology Group of Australia. Three clinical scenarios described HCDs associated with either improved overall survival, encouraging response rate in a treatment-refractory cancer, or a scenario with improved treatment tolerability. Participants were asked about their discussion and prescription of HCDs. RESULTS: There was a 78% response rate. Most respondents were male (71%), worked in a metropolitan practice (87%) and spent more than 50% of their working time in patient care (87%). Forty-eight percent had previously prescribed a HCD. In the three scenarios, respondents would generally prescribe the drug if it were subsidised, however, between 28% and 41% (depending on the scenario) would not mention the HCD if it were not subsidised. Major reasons for not mentioning the HCD were concerns that discussion would 'worry the patient' or that the doctor would 'feel bad'. CONCLUSIONS: Despite literature suggesting that patients wish to be well informed and active participants in decision making, the practice of a significant percentage of Australian medical oncologists may prevent this.
Assuntos
Antineoplásicos/economia , Custos de Medicamentos , Oncologia , Relações Médico-Paciente , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Recursos HumanosAssuntos
Difusão de Inovações , Medicina Baseada em Evidências , Tomografia por Emissão de Pósitrons/estatística & dados numéricos , Radioterapia (Especialidade)/tendências , Custos de Cuidados de Saúde , Humanos , Neoplasias/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/economia , Reino UnidoAssuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Fluoruracila/uso terapêutico , Antimetabólitos Antineoplásicos/economia , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Análise Custo-Benefício , Custos de Medicamentos , Fluoruracila/economia , Humanos , Metanálise como Assunto , Cuidados Paliativos/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de SobrevidaRESUMO
Positron emission tomography (PET) using fluorine-18 fluorodeoxyglucose (FDG) is an accurate technique for staging and therapeutic monitoring in oncology. We evaluated our use of FDG PET in an oncology centre after our first 2500 studies, and summarise our experience of PET for the major referral indications. Optimised for clinical service, PET offers lower scanning costs and therefore improved cost-effectiveness.