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The Cochrane Database of Systematic... Jul 2019Decisions in clinical medicine can be associated with ethical challenges. Ethical case interventions (e.g. ethics committee, moral case deliberation) identify and... (Review)
Review
BACKGROUND
Decisions in clinical medicine can be associated with ethical challenges. Ethical case interventions (e.g. ethics committee, moral case deliberation) identify and analyse ethical conflicts which occur within the context of care for patients. Ethical case interventions involve ethical experts, different health professionals as well as the patient and his/her family. The aim is to support decision-making in clinical practice. This systematic review gathered and critically appraised the available evidence of controlled studies on the effectiveness of ethical case interventions.
OBJECTIVES
To determine whether ethical case interventions result in reduced decisional conflict or moral distress of those affected by an ethical conflict in clinical practice; improved patient involvement in decision-making and a higher quality of life in adult patients. To determine the most effective models of ethical case interventions and to analyse the use and appropriateness of the outcomes in experimental studies.
SEARCH METHODS
We searched the following electronic databases for primary studies to September 2018: CENTRAL, MEDLINE, Embase, CINAHL and PsycINFO. We also searched CDSR and DARE for related reviews. Furthermore, we searched Clinicaltrials.gov, International Clinical Trials Registry Platform Search Portal and conducted a cited reference search for all included studies in ISI WEB of Science. We also searched the references of the included studies.
SELECTION CRITERIA
We included randomised trials, non-randomised trials, controlled before-after studies and interrupted time series studies which compared ethical case interventions with usual care or an active control in any language. The included population were adult patients. However, studies with mixed populations consisting of adults and children were included, if a subgroup or sensitivity analysis (or both) was performed for the adult population.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care review group. We used meta-analysis based on a random-effects model for treatment costs and structured analysis for the remaining outcomes, because these were heterogeneously reported. We used the GRADE approach to assess the certainty of the evidence.
MAIN RESULTS
We included four randomised trials published in six articles. The publication dates ranged from 2000 to 2014. Three studies were conducted in the USA, and one study in Taiwan. All studies were conducted on intensive care units and included 1165 patients. We judged the included studies to be of moderate or high risk of bias. It was not possible to compare different models of the intervention regarding effectiveness due to the diverse character of the interventions and the small number of studies. Included studies did not directly measure the main outcomes. All studies received public funding and one received additional funding from private sources.We identified two models of ethical case interventions: proactive and request-based ethics consultation. Three studies evaluated proactive ethics consultation (n = 1103) of which one study reported findings on one key outcome criterion. The studies did not report data on decisional conflict, moral distress of participants of ethical case interventions, patient involvement in decision-making, quality of life or ethical competency for proactive ethics consultation. One study assessed satisfaction with care on a 5-point Likert scale (1 = lowest rating, 5 = highest rating). The healthcare providers (nurses and physicians, n = 365) scored a value of 4 or 5 for 81.4% in the control group and 86.1% in the intervention group (P > 0.05). The patients or their surrogates (n = 275) scored a value of 4 or 5 for 83.6% in the control group and for 74.8% in the intervention group (P > 0.05). It was uncertain whether proactive ethics consultation led to high satisfaction with care, because the certainty of evidence was very low.One study evaluated request-based ethics consultation (n = 62). The study indirectly measured decisional conflict by assessing consensus regarding patient care. The risk (increase in consensus, reduction in decisional conflict) increased by 80% as a result of the intervention. The risk ratio was 0.20 (95% confidence interval 0.09 to 0.46; P < 0.01). It was uncertain whether request-based ethics consultation reduced decisional conflict, because the certainty of evidence was very low. The study did not report data on moral distress of participants of ethical case interventions, patient involvement in decision-making, quality of life, or ethical competency or satisfaction with care for request-based ethics consultation.
AUTHORS' CONCLUSIONS
It is not possible to determine the effectiveness of ethical case interventions with certainty due to the low certainty of the evidence of included studies in this review. The effectiveness of ethical case interventions should be investigated in light of the outcomes reported in this systematic review. In addition, there is need for further research to identify and measure outcomes which reflect the goals of different types of ethical case intervention.
PubMed: 31424106
DOI: 10.1002/14651858.CD012636.pub2 -
Frontiers in Psychology 2022The literature suggests that the moral sense is based on innate abilities. In fact, it has been shown that children show the capacity for moral discernment, emotions and...
The literature suggests that the moral sense is based on innate abilities. In fact, it has been shown that children show the capacity for moral discernment, emotions and prosocial motivations from an early age. However, the moral sense is a complex construct of an evolutionary and social nature that evolves under the influence of interpersonal relationships. The emergence and development of moral sense is a challenge that has prompted many research studies with the aim of achieving a clear comprehension of moral development. However, success has been scarce, and studies relevant to this subject are limited. Thus, a systematic review of studies relevant to this topic was conducted to clearly establish how moral sense emerges and develops. An Ovid search was conducted to retrieve relevant items for this systematic review. The databases that were electronically visited are Cross-reference, Google Scholar and PubMed. Strict inclusion and exclusion criteria were imposed on the retrieved items to retain only relevant resources. Twenty-six studies were found valid for inclusion in this systematic review. The results of these studies were presented differently: In order to effectively analyze the selected papers and bring out the results more clearly, a categorization of the approaches adopted in the studies was carried out. The approaches identified were: "Natural Moral Sense," "Social Relationships and Moral Development," and "Environmental Factors and Moral Development." The evidence that emerged from the analysis of the papers was collected to produce a general basic model that explains moral development while also serving as a link between the various studies. First, moral sense is found to be innate in humans; individuals can naturally respond morally to various dilemmas. As seen among children and young infants, moral sense naturally exists. Second, it can be socially nurtured through social interactions and exposure to various environmental factors. Various research studies were reviewed in this systematic review to obtain a consensus on how moral sense emerges and develops. From the systematic review, the moral sense is found to be innate. However, moral development is fostered by social interactions and environmental factors.
PubMed: 35615195
DOI: 10.3389/fpsyg.2022.887537 -
Journal of Pain and Symptom Management Apr 2024The provision of person-centered dignity-conserving care is central to palliative care. It is important to reevaluate current methods of assessing dignity as the concept... (Review)
Review
CONTEXT
The provision of person-centered dignity-conserving care is central to palliative care. It is important to reevaluate current methods of assessing dignity as the concept of dignity is multifaceted.
OBJECTIVES
The aim of this study is to understand the tools which are used to assess a patient's dignity and the elements of dignity evaluated in these tools.
METHODS
Two independent and concurrent Systematic Evidence-Based Approach guided systematic scoping reviews (SSR in SEBA) on existing dignity assessment tools and on accounts of assessments of dignity were carried out. The SSR in SEBA on dignity assessment tools involving PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Scopus, and CINAHL databases saw 22 full-text articles included from the 645 articles reviewed. The SSR in SEBA on accounts of assessments of dignity featured in the PubMed database identified 102 full-text articles which saw 46 articles included.
RESULTS
The domains identified were factors affecting patients' definition of dignity; elements of dignity-conserving care; and components of effective tools.
CONCLUSION
Current accounts to assess dignity and assessment tools fail to capture shifting self-concepts of dignity holistically. A portfolio-like appraisal of dignity is proposed to achieve assessments that are timely, longitudinal, and patient-specific. Portfolio-based assessments by members of the multidisciplinary team will better direct timely evaluations of relevant aspects of changing concepts of dignity, without losing the patient's holistic perception of dignity.
Topics: Humans; Palliative Care; Personhood; Respect; Systematic Reviews as Topic; Terminal Care
PubMed: 38092260
DOI: 10.1016/j.jpainsymman.2023.12.008 -
European Journal of Human Genetics :... Dec 2022Direct-to-consumer genetic testing (DTC-GT) is becoming increasingly widespread. The aim of this research was to systematically review the literature published on... (Review)
Review
Direct-to-consumer genetic testing (DTC-GT) is becoming increasingly widespread. The aim of this research was to systematically review the literature published on healthcare professionals' knowledge and views about DTC-GT, as an update to a 2012 systematic review. The secondary aim was to assess the knowledge and views of healthcare professionals on the ethical and legal issues pertaining to DTC-GT. A systematic search was performed to identify all relevant studies that have been conducted since 2012. Studies fulfilled the inclusion criteria if they were primary research papers conducted on healthcare professionals about their knowledge and views on health-related DTC-GT. PubMed, Embase, CINAHL, PsycINFO and Medline databases were searched from 2012 to May 2021. Title and abstract were screened, and full texts were reviewed by two study authors independently. New papers included were appraised and data were extracted on study characteristics, knowledge and views on DTC-GT, and ethical and legal issues. A narrative synthesis was conducted. Nineteen new papers were included, along with eight papers from the previous review. There was considerable variation in study participants with differing views, awareness levels, and levels of knowledge about DTC-GT. Genetic counsellors and clinical geneticists generally had more concerns, experience, and knowledge regarding DTC-GT. Ten ethical concerns and four legal concerns were identified. Healthcare professionals' knowledge and experience of DTC-GT, including awareness of DTC-GT ethical and legal concerns, have only minimally improved since the previous review. This emphasises the need for further medical learning opportunities to improve the gaps in knowledge amongst healthcare professionals about DTC-GT.
Topics: Humans; Delivery of Health Care; Direct-To-Consumer Screening and Testing; Genetic Testing; Health Personnel; Morals
PubMed: 36220915
DOI: 10.1038/s41431-022-01205-8 -
A Systematic Review and Meta-Analysis of the Association Between Perceived Injustice and Depression.The Journal of Pain Jun 2021Perceived injustice is increasingly recognized as a risk factor for problematic recovery, with a growing body of evidence documenting its association with heightened... (Meta-Analysis)
Meta-Analysis
Perceived injustice is increasingly recognized as a risk factor for problematic recovery, with a growing body of evidence documenting its association with heightened pain, disability, medication use, anger and post-traumatic stress. The aim of this paper was to systematically review and critically appraise the association between perceived injustice and depressive symptomatology across a wide range of medical and mental health populations, including acute and chronic pain samples. A search of published, English language studies in the PubMed, EMBASE, CINAHL, and PsycINFO databases from 1990 to June 2020 was performed. Thirty-three studies met inclusion criteria with a total sample of 5,425 individuals (61% female), primarily with acute injury or chronic pain. Results indicated a moderate to strong positive association between perceived injustice and depressive symptomatology (meta-analysis pooled effect of r = .57, 95% confidence interval [.55, .58], P< .001). A narrative synthesis of regression models indicated standardized beta coefficients between .19 and .66, with perceived injustice consistently contributing significant unique variance to the prediction of depression in final regression equations. Selection bias and response bias were common limitations in the studies. The clinical implications of an association between injustice and depression in acute and chronic pain are discussed. PROSPERO: CRD42019143465. PERSPECTIVE: This review demonstrates that in acute injury and chronic pain samples, perceived injustice is associated with depression. These findings could help clinicians in the field of pain and rehabilitation identify who may be at greater risk for a problematic recovery trajectory.
Topics: Depression; Humans; Social Justice; Social Perception
PubMed: 33465504
DOI: 10.1016/j.jpain.2020.12.009 -
American Journal of Surgery Jul 2022Previous systematic reviews have found high burnout in healthcare professionals is associated with poorer patient care. However, no review or meta-analysis has... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Previous systematic reviews have found high burnout in healthcare professionals is associated with poorer patient care. However, no review or meta-analysis has investigated this association in surgeons specifically. The present study addressed this gap, by examining the association between surgeon burnout and 1) patient safety and 2) surgical professionalism.
METHODS
A systematic review was performed in accordance with PRISMA guidelines. We included original empirical studies that measured burnout and patient care or professionalism in surgeons. Six databases were searched (PsycINFO, Ovid MEDLINE(R), EMBASE, Cochrane Database, CINAHL, and Web of Science) from inception to February 2021. An adapted version of the Cochrane Risk of Bias tool was used to assess study quality. Meta-analysis and narrative synthesis were utilised to synthesise results.
RESULTS
Fourteen studies were included in the narrative review (including 27,248 participants) and nine studies were included in the meta-analysis. Burnout was associated with a 2.5-fold increased risk of involvement in medical error (OR = 2.51, 95% Cl [1.68-3.72]). The professionalism outcome variables were too diverse for meta-analysis, however, the narrative synthesis indicated a link between high burnout and a higher risk of loss of temper and malpractice suits and lower empathy. No link was found between burnout and patient satisfaction.
CONCLUSION
There is a significant association between higher burnout in surgeons and poorer patient safety. The delivery of interventions to reduce surgeon burnout should be prioritised; such interventions should be evaluated for their potential to produce concomitant improvements in patient safety.
Topics: Burnout, Professional; Burnout, Psychological; Humans; Patient Safety; Professionalism; Surgeons
PubMed: 34974884
DOI: 10.1016/j.amjsurg.2021.12.027 -
The International Journal on Drug Policy Jul 2023In the past decade, a body of evidence has reported that dietary supplement use is related to prohibited performance enhancing substance use (i.e., doping). To help... (Meta-Analysis)
Meta-Analysis Review
In the past decade, a body of evidence has reported that dietary supplement use is related to prohibited performance enhancing substance use (i.e., doping). To help international and national sport organisations understand the degree to which dietary supplement use is related to doping, the objectives of this systematic review and meta-analysis were to 1) compare the prevalence of doping between dietary supplement users and non-users and 2) identify whether supplement use is related to doping social cognitive factors. We searched for studies sampling athletes and that measured both dietary supplement use and doping in EMBASE, MEDLINE, PsychINFO, CINAHL and SPORTDiscus from database creation to May 2022. Risk of bias was assessed using JBI Critical Appraisal Checklist for cross-sectional studies and the STROBE checklist. Twenty-six cross-sectional studies, involving 13,296 athletes were included. Random-effect models revealed that doping was 2.74 (95% CI=2.10 to 3.57) times more prevalent in dietary supplement users (pooled prevalence = 14.7%) than non-users (6.7%), and that users reported stronger doping intentions (r=0.26, 0.18 to 0.34) and attitudes (r=0.21, 0.13 to 0.28) compared to non-users. Preliminary evidence also suggests that dietary supplement users were less likely to dope if they were more task oriented and had a stronger sense of morality. Results of the review are limited by the cross-sectional design used in all studies and lack of consistency in measurement of dietary supplement use and doping. Data indicate that athletes using dietary supplements are more likely to self-report doping Anti-doping policy should, therefore, target dietary supplement use in anti-doping education programmes by providing alternative strategies for performance enhancement or highlighting the safest ways they can be consumed. Similarly, as a large proportion of athletes use dietary supplements without doping, further research is needed to understand the factors that protect a dietary supplement user from doping. No funding was received for the review. A study protocol can be found here: https://osf.io/xvcaq.
Topics: Humans; Cross-Sectional Studies; Dietary Supplements; Sports; Athletes; Intention; Doping in Sports
PubMed: 37267738
DOI: 10.1016/j.drugpo.2023.104077 -
PloS One 2022This systematic review of the literature aims to evaluate possible associations between moral judgment and hormones. The electronic databases PsycINFO, PubMed, Scielo,...
This systematic review of the literature aims to evaluate possible associations between moral judgment and hormones. The electronic databases PsycINFO, PubMed, Scielo, Web of Science, Scopus, and LILACS were used. Twenty studies with different methodological designs were reviewed, covering the hormones cortisol, oxytocin, and testosterone, assessing aspects related to polymorphisms in receptor genes, endogenous levels, and exogenous administration. Taken together, the reviewed studies showed a trend towards an association between hormones and moral judgment, with important specificities involving biological, environmental, and individual aspects. Endogenous levels of cortisol, released under stress, showed negative associations with altruistic and utilitarian decisions only in highly emotionally charged dilemmas. Oxytocin receptor gene polymorphisms (rs2268498, rs237889, and rs2254298) and acute administration of this hormone were associated with variability in moral judgment, with sex as an important moderating variable. Testosterone studies have tended to show a positive association with utilitarian moral judgments, particularly in female and in individuals with low prenatal exposure to this hormone. Knowing how hormones influence moral judgment may help expand our understanding of the plurality of human behavior. However, this area of research is new and still little explored, which does not allow for conclusions with a high level of evidence. Subsequent research will benefit from methodological improvements to extend current findings.
Topics: Female; Humans; Hydrocortisone; Judgment; Morals; Receptors, Oxytocin; Testosterone
PubMed: 35385511
DOI: 10.1371/journal.pone.0265693 -
Journal of Clinical Medicine Oct 2023Crohn's disease (CD) is a chronic inflammatory intestinal condition that can affect the entire gastrointestinal tract. It is characterized by its clinical heterogeneity... (Review)
Review
Crohn's disease (CD) is a chronic inflammatory intestinal condition that can affect the entire gastrointestinal tract. It is characterized by its clinical heterogeneity and irregularities in its course. The etiology and pathogenesis are not well established, so it is difficult to establish an early diagnosis and an effective treatment plan. The objective of this systematic review was to present a qualitative synthesis of the studies referring to the oral manifestations of CD. This systematic review was carried out following the PRISMA guide. Research was conducted in the Pubmed, Web of Science, Scopus, Scielo, and Cocrahne Library databases on 23 February 2023, and updated on 1 September 2023. Articles published between 2012 and 2023 were selected. Articles that analyzed the oral manifestation of CD patients and met the established search terms. In addition, the quality of all the selected studies was analyzed following the CARE guidelines for case reports and the STROBE scale for observational studies. A total of 19 articles were included in this review that met the inclusion criteria. Regarding the oral manifestation of CD, oral ulcers, angular cheilitis, and gingivitis stand out. Periodontitis and vegetative pyostomatitis were the least representative manifestations. The most prevalent locations were lips, mucosa, and gingivae. Ulcers, gingivitis, and angular cheilitis are the most frequent oral manifestations in patients with CD. Their early identification and possible relationship with the disease are important for an early diagnosis and an adequate treatment plan.
PubMed: 37892587
DOI: 10.3390/jcm12206450 -
BMJ Open Sep 2022Concepts of moral distress (MD) among physicians have evolved and extend beyond the notion of psychological distress caused by being in a situation in which one is...
BACKGROUND
Concepts of moral distress (MD) among physicians have evolved and extend beyond the notion of psychological distress caused by being in a situation in which one is constrained from acting on what one knows to be right. With many accounts involving complex personal, professional, legal, ethical and moral issues, we propose a review of current understanding of MD among physicians.
METHODS
A systematic evidence-based approach guided systematic scoping review is proposed to map the current concepts of MD among physicians published in PubMed, Embase, PsycINFO, Web of Science, SCOPUS, ERIC and Google Scholar databases. Concurrent and independent thematic and direct content analysis (split approach) was conducted on included articles to enhance the reliability and transparency of the process. The themes and categories identified were combined using the jigsaw perspective to create domains that form the framework of the discussion that follows.
RESULTS
A total of 30 156 abstracts were identified, 2473 full-text articles were reviewed and 128 articles were included. The five domains identified were as follows: (1) current concepts, (2) risk factors, (3) impact, (4) tools and (5) interventions.
CONCLUSIONS
Initial reviews suggest that MD involves conflicts within a physician's personal beliefs, values and principles (personal constructs) caused by personal, ethical, moral, contextual, professional and sociocultural factors. How these experiences are processed and reflected on and then integrated into the physician's personal constructs impacts their self-concepts of personhood and identity and can result in MD. The ring theory of personhood facilitates an appreciation of how new experiences create dissonance and resonance within personal constructs. These insights allow the forwarding of a new broader concept of MD and a personalised approach to assessing and treating MD. While further studies are required to test these findings, they offer a personalised means of supporting a physician's MD and preventing burn-out.
Topics: Humans; Reproducibility of Results; Physicians; Morals
PubMed: 36691160
DOI: 10.1136/bmjopen-2022-064029