Parenteral nutrition in cancer patients outside of oncologic treatment: Bioethical perspective.

BACKGROUND AND AIMS: The medical care of a patient with an end-stage disease focus on the pursuit of the patient's quality of life. Many treatments can be used to achieve this goal. In this study, the benefits, and burdens of providing parenteral nutrition to patients diagnosed with end-stage cancer were reviewed and analyzed from a bioethical perspective with the aim of issuing a useful recommendation for decision making. METHODOLOGY: A qualitative convergent study through interviews and a multiple case study was performed. The study is on the decisions to provide parenteral nutrition as an end-of-life treatment for terminal cancer patients treated in Mexico City. Eight physicians specialized in Oncology and Palliative Care were interviewed and 10 clinical records of patients diagnosed with terminal cancer, who were out of oncologic treatment, who received palliative care and were prescribed parenteral nutrition at the end of life were analyzed. RESULTS: The physicians considered parenteral nutrition as an advanced life-sustaining medical treatment and, therefore, susceptible to not being initiated or being withdrawn, according to the patient's clinical situation. Minor complications secondary to parenteral nutrition were found in all the records reviewed, all these patients died in hospital instead of at home. CONCLUSION: When death is certain in the short term and cannot be avoided, the role of feeding and nutrition becomes questionable, especially in cancer patients at the end of life, where parenteral nutrition causes more burden than benefit.

Bibliotherapy as a Non-pharmaceutical Intervention to Enhance Mental Health in Response to the COVID-19 Pandemic: A Mixed-Methods Systematic Review and Bioethical Meta-Analysis.

Background: A non-pharmaceutical treatment offered as psychological support is bibliotherapy, which can be described as the process of reading, reflecting, and discussing literature to further a cognitive shift. The coronavirus disease 2019 (COVID-19) pandemic demands a response to prevent a peak in the prevalence of mental health problems and to avoid the collapse of mental health services, which are scarce and inaccessible due to the pandemic. Thus, this study aimed to review articles on the effectiveness of bibliotherapy on different mental health problems. Methods: A systematic review was conducted to examine relevant studies that assess the effectiveness of bibliotherapy in different clinical settings as a treatment capable of enhancing a sense of purpose and its surrounding values. To achieve this, a systematic review, including a bioethical meta-analysis, was performed. A variant of the PICO (Participants, Intervention, Comparison, and Outcome) model was used for the search strategy, and the systematic review was conducted in three databases: PubMed, Bireme, and OVID. Inclusion criteria were relevant studies that included the keywords, excluding documents with irrelevant topics, studies on subjects 15 years or younger, and in languages besides Spanish or English. Starting with 707 studies, after three rounds of different quality criteria, 13 articles were selected for analysis, including a hermeneutic analysis, which was followed by a fourth and final recovery round assessing bibliotherapy articles concerning healthcare workers. Results: Our findings showed that through bibliotherapy, patients developed several capacities, including the re-signification of their own activities through a new outlook of their moral horizon. There are no research road maps serving as guides to conduct research on the use of bibliotherapy to enhance mental health. Additionally, values such as autonomy and justice were closely linked with positive results in bibliotherapy. This implies that bibliotherapy has the potential to have a positive impact in different settings. Conclusions: Our contribution is to offer a road map that presents state-of-the-art bibliotherapy research, which will assist institutions and healthcare professionals to plan clinical and specific interventions with positive outcomes.

Revisión de modelos para el análisis de dilemas éticos / Review of models for the analysis of ethical dilemmas

Resumen:En la práctica médica pediátrica es frecuente encontrar a pacientes en circunstancias que representan un dilema ético para los profesionales de la salud. Un dilema corresponde a una situación en la que los preceptos morales o las obligaciones de similar obligatoriedad ética se encuentran en conflicto, de forma que cualquier solución posible al dilema es moralmente intolerable.Una revisión de la literatura permitió identificar diferentes modelos que abordan esta clase de dilemas. Se localizaron artículos utilizando las bases de datos Ebsco Host, ProQuest, Ovid e InMex, así como metabuscadores como metacrawler. Algunos de los modelos analizados fueron los siguientes: el Modelo de Anne Davis, el Método de Nijmegen, el Método de Diego Gracia, el Método Integral, el Modelo del Centro de Ética Médica de Bochum, el Modelo de Brody y Payton, el Modelo de Curtin y Flaherty, el Modelo de Thompson y Thompson, la Fórmula SAD, el Modelo de Javier Morata, el Modelo de Elaine Congress, el Modelo IFSW, el Modelo de Loewenberg y Dolgoff, el Modelo de la Ley Social, el Método DOER, el Modelo de Brommer, el Modelo de Corey y Callanan, el Modelo de Pope y Vasquez, el Modelo de Bush, Connell y Denney, el Modelo de Ferrell, Gresham y Fraedrich y el Modelo de Hunt y Vitell.Los criterios compartidos entre los diferentes modelos fueron los siguientes: a) la especificación del dilema ético; b) la descripción de los hechos a considerar; c) la definición de valores, principios y la postura ética que será tomada en consideración; y d) la toma de decisiones con la identificación de alternativas de solución. De acuerdo con la literatura revisada, se explican algunos modelos con el fin de identificar y ejemplificar elementos críticos que pudieran ser utilizados de manera práctica por los Comités de Ética Clínica u Hospitalaria en las instituciones de salud pediátrica en México.

Abstract:In pediatric medical practice it is common to encounter situations that represent a dilemma for health professionals. A dilemma occurs when ethical problems found in professional practice cause serious internal conflicts because they imply actions that contradict their colleagues, employees, or their own personal values and are classified as personal value conflicts, conflicts with other professionals, conflicts with clients and with organizations.A literature review allowed identifying different models to debate these types of dilemmas. The present work is a review of the search of scientific articles using databases such as Ebsco Host, ProQuest, Ovid, and InMex as well as metasearch tools such as metacrawler. The models found are as follows: Model of Anne Davis, Nijmegen method, Method of Diego Gracia, Integral method, Bochum Center Ethics model, Model of Brody and Payton, Model of Curtin and Flaherty, Model of Thompson and Thompson, SAD method, Model of Javier Morata, Model of Elaine Congress, IFSW model, Model of Loewenberg and Dolgoff, Ley Social Model, DOER method, Model of Brommer, Model of Corey and Callanan, Model of Pope and Vasquez, Model of Bush, Connell and Denney, Model of Ferrell, Gresham and Fraedrich, and Model of Hunt and Vitell.The key criteria shared in the different models are a) specifying the ethical dilemma, b) description of the facts, c) value definition, moral code and facts, decision making and d) identifying alternative solutions. In order to review the literature, some models are explained with the purpose of identifying and representing critical elements that clinical ethics committees could use in a practical manner in pediatric health institutions in Mexico.

[Review of models for the analysis of ethical dilemmas]. / Revisión de modelos para el análisis de dilemas éticos.

In pediatric medical practice it is common to encounter situations that represent a dilemma for health professionals. A dilemma occurs when ethical problems found in professional practice cause serious internal conflicts because they imply actions that contradict their colleagues, employees, or their own personal values and are classified as personal value conflicts, conflicts with other professionals, conflicts with clients and with organizations. A literature review allowed identifying different models to debate these types of dilemmas. The present work is a review of the search of scientific articles using databases such as Ebsco Host, ProQuest, Ovid, and InMex as well as metasearch tools such as metacrawler. The models found are as follows: Model of Anne Davis, Nijmegen method, Method of Diego Gracia, Integral method, Bochum Center Ethics model, Model of Brody and Payton, Model of Curtin and Flaherty, Model of Thompson and Thompson, SAD method, Model of Javier Morata, Model of Elaine Congress, IFSW model, Model of Loewenberg and Dolgoff, Ley Social Model, DOER method, Model of Brommer, Model of Corey and Callanan, Model of Pope and Vasquez, Model of Bush, Connell and Denney, Model of Ferrell, Gresham and Fraedrich, and Model of Hunt and Vitell. The key criteria shared in the different models are a) specifying the ethical dilemma, b) description of the facts, c) value definition, moral code and facts, decision making and d) identifying alternative solutions. In order to review the literature, some models are explained with the purpose of identifying and representing critical elements that clinical ethics committees could use in a practical manner in pediatric health institutions in Mexico.