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Contemp Clin Trials ; 103: 106319, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33592310


INTRODUCTION: The technologies used to treat the millions who receive care in intensive care unit (ICUs) each year have steadily advanced. However, the quality of ICU-based communication has remained suboptimal, particularly concerning for Black patients and their family members. Therefore we developed a mobile app intervention for ICU clinicians and family members called ICUconnect that assists with delivering need-based care. OBJECTIVE: To describe the methods and early experiences of a clustered randomized clinical trial (RCT) being conducted to compare ICUconnect vs. usual care. METHODS AND ANALYSIS: The goal of this two-arm, parallel group clustered RCT is to determine the clinical impact of the ICUconnect intervention in improving outcomes overall and for each racial subgroup on reducing racial disparities in core palliative care outcomes over a 3-month follow up period. ICU attending physicians are randomized to either ICUconnect or usual care, with outcomes obtained from family members of ICU patients. The primary outcome is change in unmet palliative care needs measured by the NEST instrument between baseline and 3 days post-randomization. Secondary outcomes include goal concordance of care and interpersonal processes of care at 3 days post-randomization; length of stay; as well as symptoms of depression, anxiety, and post-traumatic stress disorder at 3 months post-randomization. We will use hierarchical linear models to compare outcomes between the ICUconnect and usual care arms within all participants and assess for differential intervention effects in Blacks and Whites by adding a patient-race interaction term. We hypothesize that both compared to usual care as well as among Blacks compared to Whites, ICUconnect will reduce unmet palliative care needs, psychological distress and healthcare resource utilization while improving goal concordance and interpersonal processes of care. In this manuscript, we also describe steps taken to adapt the ICUconnect intervention to the COVID-19 pandemic healthcare setting. ENROLLMENT STATUS: A total of 36 (90%) of 40 ICU physicians have been randomized and 83 (52%) of 160 patient-family dyads have been enrolled to date. Enrollment will continue until the end of 2021.

COVID-19 , Familia , Unidades de Cuidados Intensivos , Intervención basada en la Internet , Aplicaciones Móviles , Cuidados Paliativos , Relaciones Médico-Paciente/ética , COVID-19/psicología , COVID-19/terapia , Grupos Étnicos , Familia/etnología , Familia/psicología , Femenino , Humanos , Unidades de Cuidados Intensivos/ética , Unidades de Cuidados Intensivos/organización & administración , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Cuidados Paliativos/métodos , Cuidados Paliativos/psicología , SARS-CoV-2 , Apoyo Social , Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/rehabilitación
J Korean Med Sci ; 36(3): e31, 2021 Jan 18.
Artículo en Inglés | MEDLINE | ID: mdl-33463097


The coronavirus disease 2019 pandemic has caused a breakdown in the healthcare system worldwide. The need to rapidly update guidelines in order to control the transmission in the population and for evidenced-based healthcare care has led to the need for timely, voluminous and valid research. Amid the quest for a vaccine and better therapies, researchers clamouring for information has led to a wide variety of ethical issues due to the unique situation. This paper aims to examine the positive and negative aspects of recent changes in the process of obtaining informed consent. The article outlines the various aspects, from history, previously described exemptions to consenting as well as those implemented during the pandemic and the current impact of virtual methods. Further, the authors make recommendations based on the outcome of suggested adjustments described in the literature. This article looks into increasing the awareness of physicians and researchers about ethical issues that need to be addressed to provide optimal care for patients while assuring their integrity and confidentiality.

Consentimiento Informado/ética , Edición/ética , /prevención & control , /transmisión , Medicina Basada en la Evidencia , Disparidades en Atención de Salud/ética , Humanos , Pandemias , Educación del Paciente como Asunto/ética , Relaciones Médico-Paciente/ética
HEC Forum ; 33(1-2): 45-60, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33449232


This paper introduces the model of Utilitarian Principlism as a framework for crisis healthcare ethics. In modern Western medicine, during non-crisis times, principlism provides the four guiding principles in biomedical ethics-autonomy, nonmaleficence, beneficence, and justice; autonomy typically emerges as the decisive principle. The physician-patient relationship is a deontological construct in which the physician's primary duty is to the individual patient and the individual patient is paramount. For this reason, we term the non-crisis ethical framework that guides modern medicine Deontological Principlism. During times of crisis, resources become scarce, standards of care become dynamic, and public health ethics move to the forefront. Healthcare providers are forced to work in non-ideal conditions, and interactions with individual patients must be considered in the context of the crisis. The COVID-19 pandemic has forced healthcare to shift to a more utilitarian framework with a greater focus on promoting the health of communities and populations. This paper puts forth the notion of Utilitarian Principlism as a framework for crisis healthcare ethics. We discuss each of the four principles from a utilitarian perspective and use clinical vignettes, based on real cases from the COVID-19 pandemic, for illustrative purposes. We explore how Deontological Principlism and Utilitarian Principlism are two ends of a spectrum, and the implications to healthcare as we emerge from the pandemic.

Bioética , Teoría Ética , Pandemias/ética , Relaciones Médico-Paciente/ética , Ética Basada en Principios , Beneficencia , Humanos , Obligaciones Morales , Autonomía Personal , Justicia Social/ética
Qual Life Res ; 30(5): 1513-1522, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33517524


PURPOSE: Psychosocial screening for glioma patients is challenging because many patients suffer from neurocognitive deficits, which may impair assessment. This study's aim was to exploratively develop three screening questions for unmet needs to prospectively be applicable in patient-doctor consultation. METHODS: Patient interviews, a survey for health-care professionals and a weighted scoring procedure were developed for this study. Six main areas were defined according to main areas of validated questionnaires (psyche, cognition, body, role functioning, social support, unmet needs). Patients and health-care professionals rated the importance of these areas and corresponding items, patients additionally stated whether the issues addressed affected them. RESULTS: A total of 50 patients were included, and 36 health-care professionals participated in the online survey. The three areas (psyche, body and cognition) considered to be most relevant by both, health-care professionals and patients, generated three screening questions. If the patient was affected by the issue addressed with a screening question, a subordinate question from that area that our patient sample considered most important could additionally be asked. The elaborated screening questions are the following: (1) main area psyche: "Has your mood worsened?", (2) main area body: "Do physical changes put a strain on you?", and (3) main area cognition: "Has your memory capacity worsened?" CONCLUSION: These questions represent a basis for further research regarding their application in neuro-oncological clinical routine.

Neoplasias Encefálicas/psicología , Glioma/psicología , Tamizaje Masivo/métodos , Relaciones Médico-Paciente/ética , Psicología/métodos , Calidad de Vida/psicología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Apoyo Social , Encuestas y Cuestionarios
PLoS One ; 15(12): e0244303, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33370373


BACKGROUND: New challenges in the medical field of the third millennium emphasise the "humanization of medicine" leading to a redefinition of doctors' values, limits and roles. The study aims to assess whether there are different personality dimensions of physicians in relation to their perception of professional values and public expectations. METHODS: A questionnaire on the perception of professional values and the opinion on work in the medical field, work relationships and public expectations was administered to 374 doctors attending Continuing Medical Education courses. RESULTS: Two personality dimensions were identified: the first dimension (which we termed "Performance Attainment") is associated preeminently with values of competence, advocacy, confidentiality, spirit of enquiry, integrity, responsibility and commitment; the second dimension (which we called "Personal Involvement") focuses on concern and compassion. The doctors that have more difficulty accepting judgements on their activity are those who think that "Performance attainment" is less important (ß = 6.01; p-value = 0.007). Instead, the doctors who believe "public expectation of the health system" is not high enough, tend to think that "Performance Attainment" is more important (ß = -6.08; p-value = 0.024). The less importance is given to the values of "Personal Involvement", the less is the doctor's perception of having a leading role in respect to other health professionals (ß = -2.37; p-value = 0.018). CONCLUSIONS: Our results demonstrate that there are two different attitudes in terms of recognition and selection of the essential values to better practice the medical profession. Whether the doctors attach more importance to one dimension or the other, they do not differ in our analysis for how they answered the questions about relationships with patients, colleagues or family commitments in the questionnaire, even if they work in different areas. This suggests that in our research there is no single personal attitude that characterizes "a good doctor".

Actitud del Personal de Salud/etnología , Médicos/psicología , Profesionalismo/tendencias , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Percepción , Personalidad , Relaciones Médico-Paciente/ética , Encuestas y Cuestionarios
Cuad. bioét ; 31(103): 309-317, sept.-dic. 2020. tab
Artículo en Español | IBECS | ID: ibc-200023


En los últimos años el número de divorcios ha ido aumentando, siendo en ocasiones, para el paciente pediátrico, el divorcio de sus padres un elemento traumático. Nuestro objetivo fue analizar los conflictos éticos que se producen en la relación sanitaria médico-padres-hijo y de forma más específica en niños procedentes de separación/divorcio. Se realizó un estudio descriptivo mediante una encuesta compuesta de 39 items. Previamente se realizó un análisis bibliográfico exhaustivo de artículos relacionados. Nuestros resultados muestran que solo el 35% de los pediatras ha recibido formación en bioética pese a su importancia en la práctica diaria. Sobre otras cuestiones, la mayoría (57,5%) no retiraría el tratamiento de un paciente enfermo pese a que aumentara su calidad de vida, y actuaría ante una decisión equivocada de los padres (82,5%). Dan poco valor a las decisiones del menor (6,05%), raramente informados exclusivamente (5%). En cambio, se les informa primero en un 20% de los casos y en el 90% se les implica. Respecto a los progenitores, el 17,5% de las madres son informadas en exclusiva, nunca los padres. La ética tiene un valor intrínseco muy importante en las decisiones clínicas habituales, respetándose generalmente las normas y adaptándose a la situación particular de cada niño/a. En los casos en los que hay un conflicto importante, como divorcios, es importante conocer a quién se debe informar, y qué derecho tiene cada uno a decidir. Aún resulta difícil para algunos pediatras aplicar la ley 41/2002 de Autonomía del Paciente

Lately, number of divorces is increasing, nevertheless, a parents' divorce can become a traumatic problem for paediatric patients. Consequently, the aim of this study was to analyze the ethical conflicts that appear in the relationship between physician/parents/son/daughter, and more specifically those that a divorce generates. A descriptive study was developed through a survey composed by 39 items. Previously, an exhaustive bibliographic analysis was carried out. Our results show that only 35% of paediatricians interviewed have been educated in bioethics although this issue is important in daily practice. Other items show that 57,5% would not cancel a pharmacological treatment in order to improve quality of life. Also, they would react against a wrong parents' decision (82,5%). They give low value to the minor`s decision (6,05%), and rarely inform exclusively to adolescents (5%). In contrast, paediatricians sometimes ask to adolescents (20%) in first place and involved them to decide in 90% of cases. Besides, there are differences in the relation with fathers and mothers, 17,5% of mothers are informed exclusively, a fact that never hap-pens with fathers. Ethics has an intrinsic value very important in daily clinical decisions in order to respect the rules and to adapt them to the situation of every paediatric patient. When an important ethical conflict become, as a divorce is, it is essential to know who must be informed and the rights everyone has to make a decision. It is complicated to the paediatricians yet to develop 41/2002 law for Patient's autonomy

Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Relaciones Médico-Paciente/ética , Menores , Divorcio/ética , Custodia del Niño/ética , Relaciones Padres-Hijo , Pediatras/ética , Autonomía Personal , Derechos del Paciente/ética , Encuestas y Cuestionarios , Conocimientos, Actitudes y Práctica en Salud , Pautas de la Práctica en Medicina
S Afr Med J ; 110(6): 461-462, 2020 04 24.
Artículo en Inglés | MEDLINE | ID: mdl-32880552


Given the increasing numbers of ethical and legal issues arising from the COVID-19 epidemic, particularly in respect of patient-doctor confidentiality, doctors must explain to patients how the measures taken to combat the spread of the virus impact on their confidentiality. Patients must be reassured that doctors are ethically bound to continue to respect such confidentiality, but it should be made clear to them that doctors must also comply with the demands of the law. While the Constitution, statutory law and the common law all recognise a person's right to privacy, during extraordinary times such as the COVID-19 pandemic, confidentiality must be breached to a degree to halt the spread of the virus.

Confidencialidad/legislación & jurisprudencia , Infecciones por Coronavirus/epidemiología , Ética Médica , Relaciones Médico-Paciente/ética , Neumonía Viral/epidemiología , Confidencialidad/ética , Infecciones por Coronavirus/prevención & control , Humanos , Pandemias/legislación & jurisprudencia , Pandemias/prevención & control , Neumonía Viral/prevención & control
Rev. cuba. salud pública ; 46(3): e1575, jul.-set. 2020. tab, graf
Artículo en Español | LILACS, CUMED | ID: biblio-1144555


Introducción: Las condiciones crónicas de salud demandan un cuidado continuo con enfoque en el método clínico centrado en la persona, que incluye la relación médico-paciente como un elemento transversal, siendo la confianza el eje principal. Esta confianza podría mediar entre el manejo de las condiciones crónicas de los pacientes y sus efectos. Objetivo: Identificar el efecto de la confianza en la relación paciente-proveedor de salud en los diversos contextos de salud. Métodos: Se efectuó una revisión crítica de la literatura durante los meses de junio a agosto del 2017, para comprender el rol de la confianza en la relación entre el paciente-proveedor de salud y su relación con los resultados en salud. La búsqueda inicial fue con las palabras clave: confianza, médico, proveedor de salud, paciente y sus variantes en inglés y francés, en las bases de datos electrónicas JSTOR (Filosofía), Race Relations Abstracts, SocIndex with Full Text, Social Science Database, PubMed Central, CINAHL, Nursing & Allied Health Database, Web of Science, Academic Search Complete y ProQuest Central. Se aplicaron diferentes estrategias de búsqueda con las palabras claves y el operador boleano AND. Conclusiones: La confianza es una variable de la relación paciente-proveedor de salud que tiene un rol estratégico en los procesos terapéuticos. De ahí que sea fundamental considerarla como parte de la atención en salud, en especial como una instancia de colaboración y compromiso del paciente con su salud. Por lo que se hace necesario crear instrumentos que midan esta variable de acuerdo a las características culturales de los países latinoamericanos y que se extienda a todos los que tienen un rol asistencial en el contacto directo con el paciente(AU)

ABSTRACT Introduction: Health's chronic conditions demand continuous care with an approach to the clinical method focused in the person, which includes physician-patient relation as a cross-sectional element where confidence is the core. This confidence would mediate between the management of the patient's chronic conditions and their effects. Objective: To identify the effect of confidence in health provider/professional-patient relation in different health contexts. Methods: It was carried out a critical review of related literature from June to August, 2017 in order to understand the role of confidence in health provider- patient relation, and its relation with the results in health. The initial search was with the keywords: ´confidence, physician, health provider, patient and their equivalents in English and French, in the electronic databases JSTOR (Philosophy), Race Relations Abstracts, SocIndex with Full Text, Social Science Database, PubMed Central, CINAHHL, Nursing & Allied Health Database, Web of Science, Academic Search Complete and ProQuest Central. There were carried out different search strategies with the keywords and the boolean operator AND. Conclusions: Confidence is a variable of the atient-health provider relation that has a strategic role in therapeutic processes. Then, it is important to consider it as a part of health care, specially as a point of collaboration and commitment of the patient with his/her health. Thus, it is necessary to create instruments that measure this variable in accordance with the cultural characteristics of Latin American countries and this can be extended to all having a care role in the direct contact with patients(AU)

Humanos , Masculino , Femenino , Relaciones Médico-Paciente/ética , Enfermedad Crónica/psicología , Confianza/psicología
Proc Natl Acad Sci U S A ; 117(35): 21194-21200, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-32817561


Recent work has emphasized the benefits of patient-physician concordance on clinical care outcomes for underrepresented minorities, arguing it can ameliorate outgroup biases, boost communication, and increase trust. We explore concordance in a setting where racial disparities are particularly severe: childbirth. In the United States, Black newborns die at three times the rate of White newborns. Results examining 1.8 million hospital births in the state of Florida between 1992 and 2015 suggest that newborn-physician racial concordance is associated with a significant improvement in mortality for Black infants. Results further suggest that these benefits manifest during more challenging births and in hospitals that deliver more Black babies. We find no significant improvement in maternal mortality when birthing mothers share race with their physician.

Grupos Étnicos/psicología , Mortalidad Infantil/tendencias , Relaciones Médico-Paciente/ética , Comunicación , Grupos de Población Continentales/etnología , Grupos de Población Continentales/psicología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Médicos , Estados Unidos
PLoS One ; 15(7): e0236145, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32687536


PURPOSE: Relationship boundaries recognition is an essential element of medical practice. The aim of the study was to assess final year medical students' perceived need for education regarding professional boundaries. MATERIALS AND METHODS: This was a cross-sectional study. An anonymous paper questionnaire was distributed to 128 final year medical students. Standard descriptive statistics, unpaired t-test to evaluate differences between male and female groups and Pearson correlation to determine relationships between variables were used. RESULTS: The survey was completed by 84.4% of students who identified the need for more emphasis in the curriculum for all of topics during training and practice pertaining to boundaries and relationships (mean 6.61±1.32 on a scale of 0 to 9; and 6.66±1.27 respectively). Topics with a high interest ranking requiring additional attention were mistreatment of medical students (mean 7.22±1.96), coping with mistakes in clinical care (mean 7.25±1.63), reporting of medical mistakes (mean 7.58±1.36), and gender bias in clinical care (mean 7.10±1.82). Women perceived a greater need for attention to all topics in the curriculum. Significant differences between the perceptions of female and male students were observed regarding topics such as responding to an impaired colleague (p<0.001), and a physician's social responsibilities (p = 0.001). CONCLUSION: Medical students recognized the need for more education and training in the undergraduate medical ethics curriculum regarding patient-physician relationship boundaries.

Prácticas Clínicas , Aprendizaje , Relaciones Médico-Paciente/ética , Adulto , Estudios Transversales , Ética Médica , Femenino , Humanos , Masculino , Factores Sexuales , Encuestas y Cuestionarios , Adulto Joven
BMJ ; 370: m1668, 2020 07 20.
Artículo en Inglés | MEDLINE | ID: mdl-32690477


Despite their ubiquitous presence, placebos and placebo effects retain an ambiguous and unsettling presence in biomedicine. Specifically focused on chronic pain, this review examines the effect of placebo treatment under three distinct frameworks: double blind, deception, and open label honestly prescribed. These specific conditions do not necessarily differentially modify placebo outcomes. Psychological, clinical, and neurological theories of placebo effects are scrutinized. In chronic pain, conscious expectation does not reliably predict placebo effects. A supportive patient-physician relationship may enhance placebo effects. This review highlights "predictive coding" and "bayesian brain" as emerging models derived from computational neurobiology that offer a unified framework to explain the heterogeneous evidence on placebos. These models invert the dogma of the brain as a stimulus driven organ to one in which perception relies heavily on learnt, top down, cortical predictions to infer the source of incoming sensory data. In predictive coding/bayesian brain, both chronic pain (significantly modulated by central sensitization) and its alleviation with placebo treatment are explicated as centrally encoded, mostly non-conscious, bayesian biases. The review then evaluates seven ways in which placebos are used in clinical practice and research and their bioethical implications. In this way, it shows that placebo effects are evidence based, clinically relevant, and potentially ethical tools for relieving chronic pain.

Dolor Crónico/tratamiento farmacológico , Relaciones Médico-Paciente/ética , Placebos/efectos adversos , Pautas de la Práctica en Medicina/ética , Teorema de Bayes , Dolor Crónico/psicología , Decepción , Método Doble Ciego , Ética Médica , Humanos , Efecto Placebo , Placebos/administración & dosificación , Pautas de la Práctica en Medicina/estadística & datos numéricos
Rev. bioét. derecho ; (49): 7-23, jul. 2020.
Artículo en Español | IBECS | ID: ibc-192091


El objetivo de este artículo es definir y clarificar el criterio del mejor interés (CMI) como un principio ético para la toma de decisiones por representación. En primer lugar, se exponen algunas propuestas conceptuales como la de Kopelman y Buchanan y Brock. En segundo lugar, analizamos algunas críticas que se han hecho al CMI. Por último, este trabajo responde algunas críticas y hace una propuesta integradora

The aim of this paper defines and clarifies the best interest criterion (BIC) as an ethical principle to substitute decision-making. First, this work exposes some conceptual proposals such as Kopelman and Buchanan and Brock. Second, the authors analyze some criticisms that have been made to BIC. Third, we want to respond such critics and we do a conciliatory proposal

L'objectiu d'aquest article és definir I clarificar el criteri del millor interès (CMI) com un principi ètic per a la presa de decisions per representació. En primer lloc, s'exposen algunes propostes conceptuals com la de Kopelman I Buchanan I Brock. En segon lloc, analitzem algunes crítiques que s'han fet al CMI. Finalment, aquest treball dóna resposta a algunes crítiques I fa una proposta integradora

Humanos , Niño , Toma de Decisiones/ética , Pediatría/ética , Bioética , Relaciones Médico-Paciente/ética , Competencia Mental/legislación & jurisprudencia , Privación de Tratamiento/legislación & jurisprudencia , Moral
Rev. bioét. derecho ; (49): 25-40, jul. 2020.
Artículo en Español | IBECS | ID: ibc-192092


La relación médico-paciente se encuentra en un proceso de cambio y evolución hacia un tratamiento más humano, sustentado sobre el principio de autonomía, con el objetivo de respetar los derechos del paciente y no sólo imponer la voluntad del médico. Un instrumento que salvaguarda esta situación es el Documento de Voluntades Anticipadas, como extensión del consentimiento informado. A pesar de su regulación internacional y nacional, en ciertos contextos, como el de la salud mental, el modelo hegemónico-paternalista sigue imperando y nos preguntamos por qué

The doctor-patient relations are undergoing a process of change and evolution towards a more humane approach, based on the principle of autonomy , with the aim of respecting the rights of patients and not just imposing the will of the phyisician. Advance Directives, as an extension of Informed Consent documents, can further safeguard such rights. Despite its international and national regulation, in certain contexts, such as mental health, the hegemonic-paternalistic model persists, and the authors question the underlying motive

La relació metge-pacient es troba en un procés de canvi I evolució cap a un tractament més humà basat en el principi d'autonomia, amb l'objectiu de respectar els drets del pacient I no només imposar la voluntat de metge. Un instrument que salvaguarda aquesta situació és el Document de Voluntats Anticipades, com a extensió del consentiment informat. Malgrat la seva regulació internacional I nacional, en certs contextos, com el de la salut mental, el model hegemònic-paternalista segueix imperant I ens preguntem per què

Humanos , Directivas Anticipadas/ética , Directivas Anticipadas/legislación & jurisprudencia , Legislación Médica , Salud Mental/ética , Enfermos Mentales/legislación & jurisprudencia , Planificación/ética , Salud Mental/legislación & jurisprudencia , Planificación/legislación & jurisprudencia , Relaciones Médico-Paciente/ética , Autonomía Personal , Atención Dirigida al Paciente/ética
Rev. salud pública ; 22(3): e184536, May-June 2020.
Artículo en Inglés | LILACS | ID: biblio-1115880


ABSTRACT This article attempts to reflect on the importance of thinking in general about illness and about cancer, from an ethical perspective. This approach reveals the central role of personal dignity and the moral relevance that supports the reasons for respecting people. The ethical values that sustain the practice of medicine must aim at uplifting this dignity and seeking situations of justice, since living in a community expresses intersubjectivity that cannot be truncated by illnesses like cancer. Therefore, situations involving poverty cannot justify the lack of health care, and if such lacks occur, they run counter to ethical awareness in the deepest sense and destroy intersubjectivity. As a result, cancer is suffered as a vital experience, in a framework of lives that are lived and are not simply objects of study; those stricken with cancer are individuals who are denied the human right to health, and undergo the elimination of their dignity, the cancelation of justice, and a death sentence. Society is part of these actions and at the same time, suffers from the disappearance of hope. In this sense, the process of informed consent is used as a tool that encourages dialog and understanding between doctors and patients during proper treatment, on a shared path.(AU)

RESUMEN El artículo pretende hacer una reflexión sobre la importancia de pensar, en general, la enfermedad y, en particular, el cáncer, desde una perspectiva ética. Este acercamiento permite vislumbrar el papel central que tiene la dignidad de las personas y la relevancia moral que apuntalan las razones por las cuales ellas han de ser respetadas. Los valores éticos que sustentan la práctica médica han de apelar a enaltecer dicha dignidad y buscar situaciones de justicia, dado que vivir en comunidad da cuenta de una intersubjetividad que no puede ser truncada por enfermedades como el cáncer. Esto evidencia que las situaciones de pobreza no pueden justificar la carencia de cuidados de salud y que, cuando esto sucede, se contraviene, desde lo más hondo, una conciencia de carácter ético y se rompe la intersubjetividad. El cáncer se sufre en tanto experiencia vital, en un marco de vidas vividas y no simplemente de objetos de estudio; los enfermos son personas a quienes se les niega el derecho humano de la salud, se les borra su dignidad, se cancela la justicia y se les condena a la muerte. La sociedad es parte de estas acciones y a la vez sufre la cancelación de esperanzas. En este sentido, se retoma el proceso del consentimiento informado (CI) como una herramienta que permite el diálogo y la comprensión entre médicos y pacientes en la atención digna, en un camino compartido.(AU)

Justicia Social/ética , Personeidad , Consentimiento Informado/ética , Neoplasias/psicología , Relaciones Médico-Paciente/ética , Pobreza
Rev. fac. cienc. méd. (Impr.) ; 17(1): 15-25, ene.-jun. 2020. tab
Artículo en Español | LILACS | ID: biblio-1223627


Según la Organización Mundial de la Salud, la hipertensión arterial se considera una de las principales causas de muerte a nivel mundial, afecta aproximadamente a uno de cada cuatroadultos, reduciendo la esperanza de vida; la intervención oportuna, eficaz y con calidad, permitirá prevenir complicaciones agudas y/o retardar complicaciones crónicas. Objetivo:evaluar el grado de satisfacción en la calidad deatención, que se brinda a personas hipertensas, mayores de 20 años, con más de un año de evolución, en los servicios ambulatorios, del municipio de Gracias, departamento de Lempira, abril 2017-abril 2018. Material y Métodos:estudio descriptivo, transversal y fenomenológico,evalúael grado de satisfacción en la calidad de atención a personas hipertensas, mayores de 20 años usuarios de losservicios ambulatorios. Los datos cuantitativos se obtuvieron mediante 60 encuestas y fueron analizadas a través de Epi Info; los datos cualitativos se registraron mediante 10 entrevistas grabadas y transcritas, posteriormente codificadas y analizadas. Resultados:la mayoría de los pacientes estudiados fueron del sexo femenino 46(76.7%), ≥ 60 años 33(55.0%), procedencia urbana 38(63.3%), ingresos económicos < L. 4 224.20 28(46.6%); con antecedentes personales patológicos de obesidad/sobrepeso 23(32.4%), diabetes mellitus 17(24.0%); siendo informados por el personal de salud sobre alimentación adecuada 58(96.7%), medidas para evitar sobrepeso u obesidad 46(76.7%) y 35(58.3%) fueron informados sobre cómo reconocer complicaciones de la hipertensión arterial. Los recursos humanos valorados como ­Bueno‖ fueron enfermería 45(75.0%) y personal médico 29 (48.3%). Calificando como Buena la atención recibida 36(60.0%), apreciándose en los resultados cualitativos, la satisfacción en la calidad de atención, en las dimensiones de: empatía, fiabilidad y seguridad. Conclusión:la mayoría de los usuarios, mostraron satisfacción con la calidad de atención brindada por el personal de salud, no obstante, presenta insuficiencias en lo relativo a recursos humanos, materiales y medicamentos...(AU)

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Satisfacción del Paciente , Hipertensión/diagnóstico , Relaciones Médico-Paciente/ética , Calidad de la Atención de Salud
J Med Internet Res ; 22(5): e15685, 2020 05 05.
Artículo en Inglés | MEDLINE | ID: mdl-32369028


BACKGROUND: Gift giving from patients to physicians, which is prohibited in traditional clinical settings in China, has been found to occur in online health communities. However, there is debate on the validity of online gifts since physicians gain an economic benefit. Moreover, the potential impact of these gifts, particularly with respect to the financial value of the gift, on the online consultation service quality remains unexplored. OBJECTIVE: The aim of this study was to explore the impact of gift price on the quality of physicians' online consultation service. Insight into this impact is expected to help resolve existing debate on the appropriateness of the gift-giving practice in online consultations. METHODS: A dataset of 141 physicians and 4249 physician-patient interactions was collected from the Good Physician Online website, which is the largest online consultation platform in China. Based on social exchange theory, we investigated how gift price affects the quality of physicians' online consultation service and how this impact changes according to the physician's service price and number of all gifts received. Manual annotation was used to identify the information support paragraphs and emotional support paragraphs in the answers of physicians. The quality of the information support paragraphs, rather than the complete answer, was used to test the robustness of our model. RESULTS: Gift price had a positive impact on the quality of physicians' online consultation service (ß=4.941, P<.01). This impact was negatively mediated by both the physician's service price (ß=-9.245, P<.001) and the total number of gifts they received (ß=-5.080, P<.001). CONCLUSIONS: Gift price has a positive impact on physicians' online behavior, although the impact varies among physicians.

Donaciones , Relaciones Médico-Paciente/ética , Telemedicina/métodos , Adulto , Investigación Empírica , Femenino , Humanos , Masculino
Pediatrics ; 145(6)2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32398328


A 15-year-old girl is scheduled to undergo an upper lobectomy to debulk metastatic Ewing sarcoma. The anesthesiologist recommended placement of a thoracic epidural catheter to provide postoperative analgesia. The patient did not want a needle to be placed near her spine. She was terrified that the procedure would be painful and that it might paralyze her. Although the anesthesiologist reassured her that sedation and local anesthesia would make the procedure comfortable, she remained vehemently opposed to the epidural procedure. The parents spoke privately to the anesthesiologist and asked for placement of the epidural after she was asleep. They firmly believed that this would provide optimal postoperative analgesia and thus would be in her best interest. Experts discuss the pros and cons of siding with the patient or parents.

Conducta del Adolescente/ética , Anestesia Epidural/ética , Dolor Postoperatorio/prevención & control , Relaciones Padres-Hijo , Relaciones Médico-Paciente/ética , Negativa del Paciente al Tratamiento/ética , Adolescente , Conducta del Adolescente/psicología , Anestesia Epidural/métodos , Anestesia Epidural/psicología , Neoplasias Óseas/psicología , Neoplasias Óseas/cirugía , Femenino , Humanos , Dolor Postoperatorio/psicología , Padres/psicología , Sarcoma de Ewing/psicología , Sarcoma de Ewing/cirugía , Negativa del Paciente al Tratamiento/psicología