Academic literature on the topic 'Professional-patient relations – ethics'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the lists of relevant articles, books, theses, conference reports, and other scholarly sources on the topic 'Professional-patient relations – ethics.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Journal articles on the topic "Professional-patient relations – ethics"
1
Losevich, Marina, Aigars Laizāns, and Inga Kudeikina. "Aspects of Contractual Relations in Healthcare." SOCRATES. Rīgas Stradiņa universitātes Juridiskās fakultātes elektroniskais juridisko zinātnisko rakstu žurnāls / SOCRATES. Rīga Stradiņš University Faculty of Law Electronic Scientific Journal of Law 3, no. 24 (2022): 91–105. http://dx.doi.org/10.25143/socr.24.2022.3.091-105.
Full textAbstract:
The article aims to determine the scope and limitations of ethical duties and legal responsibilities of the medical practitioner within the professional-patient relationship (PPR), identify shortcomings of the legal framework and gaps in ethical principles, and propose solutions to them. It argues that in private law the healthcare shares many similarities with conractual law; therefore, the legal basis for physician-patient relationship is the special legal capacity of the contract parties and their free will, but ethical basis ‒ their good faith. One important finding is that physician right and obligation to refuse is an aspect of patient safety and quality of healthcare and has to be acknowledged by ethics and stipulated by law. In addition, it detects that medical professionals are ethically and legally vulnerable and need special protection. All this calls to carving out the proper place of medical practitioners’ professional autonomy and freedom in current legal regulation. Used materials include literature and scientific publications on clinical and research bioethics, contractual and medical law, regulatory enactments, court judgments. Methods used in the study include descriptive, analysis, synthesis, dogmatic, induction and deduction; legal interpretation methods such as grammatical and systemic. Keywords: patient’s rights, physician’s rights, physician’s autonomy, professional-patient relationship, right to refuse, medical liability
2
Semenoh, Olena, and Olena Kravchenko. "PROFESSIONAL ETHICS IN LINGUA-CULTURAL DIMENSIONS: AMERICAN EXPERIENCE." Aesthetics and Ethics of Pedagogical Action, no. 16 (September 9, 2017): 70–83. http://dx.doi.org/10.33989/2226-4051.2017.16.175981.
Full textAbstract:
The article outlines the concepts "nurse", "professional ethics of nurses." The professional ethics of nurses has been defined as a component of medical ethics which studies moral consciousness, moral and ethical aspects of professional activity, moral principles and values that regulate the moral relationship between s nurse and s patient, the patient's family, other members of the medical community and community. The analysis of foreign and Ukrainian experience of formation of nurses’ professional ethics gives grounds to characterize the quality as a set of interrelated cognitive, praxeological, communicative components; their presence allows to interact productively with the professional and social environment on the basis of professionally important ethical knowledge, skills, professional important qualities that are aimed at the effective organization of the medical-preventive process and the solution of professional tasks. The content of the professional ethics of a future nurse consists of ethical categories and professionally important ethical qualities such as: professional duty, responsibility, dignity, conscience, honor, respect, mercy, empathy, tolerance.The peculiarities of educational programs of future licensed younger nurses training (LPN) in the United States aimed at the formation of professional ethics have been outlined. A review of the linguistic- cultural aspect of the formation of nurses’ professional ethics at American higher education institutions has been conducted. The experience of classes on "Nursing Ethics", "Foreign Language" at Cherkasy Medical Academy has been presented; they are aimed at understanding the world of the profession, the culture of communication in medical community, ethical behavior, moral relations, prevention of conflict situations, and provision of psychological support.
3
Leonova, Olga M., and Alexander N. Salnikov. "Historical aspects and organizational issues of deontology in dental institutions." Medicine and Physical Education: Science and Practice, no. 9 (2021): 39–44. http://dx.doi.org/10.20310/2658-7688-2021-3-1(9)-39-44.
Full textAbstract:
A large number of works are devoted to the problem of medical ethics and deontology. They mainly consider the relationship between a medical worker and a patient, a medical worker and society. The issue of adherence to medical deontology and ethics between doctors is not often raised in the professional literature. We considered issues of relationship of the health worker and patient, the personal qualities of the doctor and moral installations defining his behavior; relations with colleagues and rationing the vocational and ethical field of medicine in the form of a vocational and ethical code. The key principles of bioethics are the following: the principle of humanism, professionalism, the scientific nature of medical interventions, self-criticism. Modern successes in the field of science and technology, the transfer of their results to medical practice have determined the relevance of the relationship between the doctor and the patient from the point of view of law, morality and religious beliefs. This problem area is the subject of biomedical ethics, the task of which is to solve ethical problems closely related to medical practice and biomedical research. We defined modern medical ethics through correlation with the bioethical model.
4
Znagovan, Alexandru. "Morality, ethics, and professional deontology: non-traditional sources of medico-pharmaceutical law." Moldovan Journal of Health Sciences 10, no. 1 (April 2023): 65–72. http://dx.doi.org/10.52645/mjhs.2023.1.10.
Full textAbstract:
Introduction. Moral, ethical, and professional deontological rules have a substantial impact on the social relations of legal regulation regarding liability for abuses and violations of citizens’ rights – people taking medication – patients as part of the health care system. The identification of the place and role of moral norms, ethics, and professional deontology, their quality as specific non-traditional primary sources in the development of the health care system, and the sub-branch of pharmaceutical law in the Republic of Moldova were the focus of the present study. Material and methods. The secondary descriptive synthesis study of normative-legal acts as primary specific non-traditional sources, viewed through the lens of the protection of the rights of the consumer of medicines, the patient – the ultimate beneficiary of the social relations in the field of health care – spanned the years 1991 to 2021. The most relevant sources subject to analysis are the Constitution of the Republic of Moldova, the Code of Ethics for doctors and pharmacists in the Republic of Moldova, laws, and sub-legislative acts, etc. The study is based on the use of several recognized techniques and methods of analysis: systemic approach, synthesis, logical-legal deduction, content and comparative analysis, etc. Results. Both the literature and recognized authors state that respect for moral, ethical, bioethical, and professional deontological norms in the field of health care has always been highly appreciated in society, which has led to the recognition of the nobility of medical and pharmaceutical activity. The results presented in this paper have made it possible to highlight aspects that recommend that the investigation of the role of legal regulation in medical and pharmaceutical activities also question the place and role of moral, ethical, and bioethical norms, as they generally have the same thematic orientation and influence on law, legislation, the practice of applying the law, and vice versa. Conclusions. The accomplished study allowed the identification of the dialectical and organic unity between moral, ethical, bioethical, and deontological sources with the rules of law - the moral-legal foundation of medico-pharmaceutical law. The consolidation of legal and moral norms demonstrates the structuring of the sub-branch of medico-pharmaceutical law. The analysis of the normative-legal acts in the Republic of Moldova confirms both the functionality of the „moral-ethics-deontology-law” system and the importance given to the protection of the rights of the consumer of medicines, the patient, as the ultimate beneficiary of social relations in the field of health care.
5
Wang, Zekun, Zhaohua Deng, and Xiang Wu. "Status Quo of Professional–Patient Relations in the Internet Era: Bibliometric and Co-Word Analyses." International Journal of Environmental Research and Public Health 16, no. 7 (April 2, 2019): 1183. http://dx.doi.org/10.3390/ijerph16071183.
Full textAbstract:
Background: Incidents of violence against medical staff have increased in intensity, showing the deteriorating relationship between doctors and patients in China over the past few years. In addition, professional–patient relations have been significantly affected in the Internet era in China, which has attracted great attention from many scholars. This study aims to analyze the research status of professional–patient relations in the Internet era in China and further reveal its research pattern and trends. Methods: This study collected journal articles published during the past 21 years from the Wanfang Data Knowledge Service Platform. Then, bibliometric analysis was carried out, including publication growth, core author and collaborative degree, highly cited papers, journal distribution, and institution distribution analyses. We also analyzed the subject heading–source literature matrix and co-occurrence matrix of keywords through hierarchical cluster, social network, and strategic diagram analyses. Results: The number of articles has continually risen since 1998, which follows the growth law of literature. Furthermore, the distribution of these studies obeys Bradford’s law of scattering, and mainly concentrates on the fields of medicine and health technology. The distribution of high-frequency keywords follows Zipf’s law. Conclusions: We identified eight focal research directions, namely: website building (especially for professional–patient interaction), telemedicine, professional–patient communication and network public opinion, professional–patient contradiction and health education, new media, follow-up interaction platform, healthcare reform and computer network, and medical ethics.
6
Sergeev, V. V., and I. A. Shmelev. "The combination of moral and law norms in regulation of medical activity." Problems of Social Hygiene, Public Health and History of Medicine 31, no. 1 (December 15, 2023): 88–92. http://dx.doi.org/10.32687/0869-866x-2023-31-1-88-92.
Full textAbstract:
The article considers proposals developed according results of the study and targeted on improving social regulation of medical activities on basis of complex institutional approach. The complexity of approach lies in the fact that in regulation of public relations in health care opposition between norms of law and norms of morality is not allowed because in medicine they inter-condition and inter-complement each other. The institutional aspect of approach is reflected in tight interaction of moral and legal foundations, as well as in mechanisms of implementation of social standardization of specific sphere of medical activity. The formalized model of integrated institutional approach is presented. The importance of bioethics, in which principle of inter-complementarity of morality and law is realized to its maximum extent is emphasized. The significance of structural principles of bioethics that characterize totality of stable relationships of subjects of medical intervention is highlighted. The emphasis is made on interrelation between principles of bioethics and medical ethics, on norms of medical ethics, that largely determine content of professional duty of physician. The norms of medical ethics are grouped into three systems: “doctor-patient”, “doctor-colleague” and “doctor-society” that are contained in international ethical documents and “The Code of Professional Ethics for Physicians” of the Russian Federation. The importance of internal and external mechanisms of implementation of complex social regulation of medical activity is marked.
7
Pinto Marques, A. Franklim. "A profession, a (bio)ethics. A conceptual vision." Anales de la Real Academia Nacional de Farmacia 89, no. 89(02) (June 30, 2023): 177–89. http://dx.doi.org/10.53519/analesranf.2023.89.02.04.
Full textAbstract:
The pharmaceutical profession has a unique scope of intervention in the area of health, where the pharmacist can be found in all domains related to access to health care, at its most varied levels. All this scope is based on a broad academic training, where scientific knowledge and expertise confer skills that are directly reflected on the pharmaceutical profession and practice. The professional practice of the pharmacist is very diverse and can be observed in various circumstances, from direct contact with the patient, with the person, as in community pharmacy, hospital pharmacy, clinical analysis laboratory, palliative or continuous care, in nursing homes, to in more reserved situations, such as in the laboratory or in scientific and clinical research. This wide range of activity of the pharmacist, supported by individual labor relations or integrated into multidisciplinary health teams, requires from him an assertive behavior and a (bio)ethical awareness that allows him to respond to the different demands he faces in his daily life. It is important, therefore, to reflect on the concepts and assumptions that ethics or bioethics have in the professional life of pharmacist, in the area of health and life sciences, and in the personal life of each one.
8
Al-Balushi, Amal A. "In the Era of Social Media: Is it time to establish a code of online ethical conduct for healthcare professionals?" Sultan Qaboos University Medical Journal [SQUMJ] 20, no. 1 (March 9, 2020): 25. http://dx.doi.org/10.18295/squmj.2020.20.01.004.
Full textAbstract:
Social media is becoming an invasive part of the lives of many professionals including those in the healthcare field. One of the countless implications of such an invasion is how the healthcare professional’s engagement with social media affects the traditional doctor-patient relationship. The online presence of professionals should be carefully self-monitored as it affects the individual’s reputation and society’s perception of their profession. Therefore, the contents of public and personal accounts must differ according to their purpose. In the public eye, conflicts of interest must be declared and scientifically-based medical advice should be clearly differentiated from experience-based advice, personal opinions or commercial advertisements. Online doctorpatient relationships risk the privacy of patients as well as the personal privacy of the healthcare professional. Personal accounts created for friends and family should be kept separate from public accounts created for educational, professional or commercial purposes. Published educational material should be clearly differentiated from commercial material so that it is easier for the public to make an informed decision. This paper proposes a code of online ethical conduct to be implemented in Oman.Keywords: Codes of Ethics; Social Media; Health Personnel; Privacy; Confidentiality; Conflict of Interest; Physician-Patient Relations; Oman.
9
Kaya, Ayla, and İlkay Boz. "The development of the Professional Values Model in Nursing." Nursing Ethics 26, no. 3 (September 20, 2017): 914–23. http://dx.doi.org/10.1177/0969733017730685.
Full textAbstract:
One of the most important criteria for professionalism is accumulation of knowledge that is usable in professional practice. Nursing models and theories are important elements of accumulating nursing knowledge and have a chance to guarantee the ethical professional practice. In recent years, there has been an increase in the use of models in nursing research and newly created terminology has started to be used in nursing. In this study, a new model, termed as the Professional Values Model, developed by the authors was described. Concepts comprising the conceptual framework of the model and relations between the concepts were explained. It is assumed that awareness about concepts of the model will increase not only the patients’ satisfaction with nursing care, but also the nurses’ job satisfaction and quality of nursing care. Contemporary literature has been reviewed and synthesized to develop this theoretical paper on the Professional Values Model in nursing. Having high values in nursing increases job satisfaction, which results in the improvement of patient care and satisfaction. Also, individual characteristics are effective in the determination of individual needs, priorities, and values. This relation, proved through research about the Professional Values Model, has been explained. With development of these concepts, individuals’ satisfaction with care and nurses’ job satisfaction will be enhanced, which will increase the quality of nursing care. Most importantly, nurses can take proper decisions about ethical dilemmas and take ethical action when they take these values into consideration when giving care. The Professional Values Model seems suitable for nurse managers and it is expected that testing will improve it. Implementation of the Professional Values Model by nurse managers may increase motivation of nurses they work with. It is suggested that guidance by the Professional Values Model may help in enhancement of motivation efforts of the nurse managers and therefore should be taken into account.
10
FAVACHO, Natasha Costa. "MEDICAL PROPAGANDA." RCMOS - Revista Científica Multidisciplinar O Saber 1, no. 2 (January 22, 2024): 20–45. http://dx.doi.org/10.51473/rcmos.v1i2.2021.29.
Full textAbstract:
Objectives: This study evaluates, firstly, the distinction between the terms advertising and propaganda and its application to medical activity, justifying the choice of the term "propaganda" in the title of this article. In a second moment, the research approaches the normative framework that allows the Federal and Regional Medical Councils to regulate the limits and restitions to advertisement by doctor and to adopt the appropriate measures and sanctions in case of violation of legal and ethical norms in doctor-patient relations. Afterwards, the normative and deontological diplomas, their respective permissions and prohibitions of conduct of the medical professional when advertising on social networks are analyzed. Finally, the practices of use of social networks by doctors are outlined in accordance with medical ethics and the law, reaching the conclusion that it is fully possible for doctors to advertise on social media, provided that the legal and deontological parameters of the profession are followed. Methods: This article analyzes the possibility of medical professionals to use advertising tools in social networks, through bibliographic research of texts contained in works on Medical Law and legal analysis about the legal and deontological norms that govern medical activity in Brazil. The Boolean indicators used for research of the titles were "and" and "or", from the following descriptors: "Propaganda", "Advertising" and "Social Networking" and " Physician-Patient Relations", all extracted from DeSC.
Dissertations / Theses on the topic "Professional-patient relations – ethics"
1
Gonçalves, Patrícia Elaine [UNESP]. "Avaliação do conhecimento dos cirurgiões dentistas que realizam curso de especialização na Universidade Estadual Paulista-UNESP, sobre aspectos bioéticos, éticos e legais do tratamento odontológico." Universidade Estadual Paulista (UNESP), 2005. http://hdl.handle.net/11449/95418.
Full textAbstract:
Made available in DSpace on 2014-06-11T19:27:45Z (GMT). No. of bitstreams: 0
Previous issue date: 2005-12-13Bitstream added on 2014-06-13T19:15:10Z : No. of bitstreams: 1
goncalves_pe_me_araca.pdf: 343612 bytes, checksum: 732c1747b04c880385b3be6634947064 (MD5)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Os aspectos bioéticos, éticos e legais não devem ser negligenciados pelos cirurgiões-dentistas durante o tratamento odontológico, pois este não se restringe apenas ao ato clínico, mas abrange desde a relação profissional/paciente até a documentação odontológica. Este estudo teve como objetivo avaliar o conhecimento dos cirurgiões-dentistas (n=163) que realizam curso de especialização na Universidade Estadual Paulista - UNESP, sobre esses aspectos. Foi realizado um estudo transversal descritivo, por meio de um questionário semi-estruturado. As respostas quantitativas foram analisadas pelo programa Epi Info 6.0.4, por meio de levantamento das porcentagens e as respostas qualitativas, através da análise de conteúdo, pela técnica de análise categorial, conforme preconizado por Bardin (1994). Em relação aos aspectos bioéticos, 88,1% citam que a decisão sobre o tratamento deve ser resultado em comum acordo entre o profissional e o paciente, porém 26,4% relatam que a participação do paciente e/ou seu representante legal pode interferir de maneira negativa, quando os mesmos optam pelo tratamento menos vantajoso. Já a atuação do profissional, quando o paciente escolhe um tratamento menos conveniente, 95,6% dos entrevistados tentam convencê-lo a optar pelo tratamento melhor. Apesar de todos os entrevistados considerar importante à interação profissional/paciente, 20,3% não souberam relacionar sua importância para o tratamento odontológico. Sobre os aspectos éticos, observamos que 89,4% alegam apresentar todas as alternativas de tratamento quando o caso possui mais de uma, mas a linguagem utilizada por 48,1% dos entrevistados é técnica, dificultando o entendimento do paciente. Antes do tratamento odontológico, apenas 22,6% obtém o consentimento livre e esclarecido, enquanto 48,4 % dos pesquisados adquirem a autorização do paciente.
The bioethics, ethicals and legals aspects should not be neglectful by the dentist-surgeons during dental treatment, because it doesn't limit to the clinical action, but it includes since the professional/patient relationship to the dental documentation. Our study aimed at evaluating dentist-surgeons' knowledge (n=163) when conducting specialization courses at São Paulo State University - UNESP, on these aspects. A descriptive traversal study was conducted, through a semi-structured questionnaire. The quantitative answers were analyzed by the program Epi Info 6.0.4, through survey of the percentages and the qualitative answers, through the content analysis, by category analysis technique as advocated by Bardin (1994). In relationship to bioethics aspects, Out of the people surveyed, 88.1% mentioned that a decision for the dental treatment should be made by mutual agreement between professionals and patients, however, 26.4% report that patients' or their legal representative's participation in treatment decision-making can cause negative interference, since they can choose a type of treatment that dentist-surgeons will not deem as the most proper one. On professionals' acting when patients choose a less suitable treatment, 95.6% of these try to convince patients that it is not the best choice and persuade them for a better one by keeping the paternalistic model. It was noticed that 20.3% did not know how to relate the importance of professionalpatient interaction as regards the dental treatment. About the ethical aspects, 89.4% alleged that they inform patients about all the alternatives of treatment when the case involves more than one. As regards the legal ethical test requested to patients prior to treatment, only 22.6% ask for the informed consent term, while 48.4% obtain the authorization.
2
Chow, Judy. "Vårdandets Tao : En fenomenologisk studie om vårdrelationer i Kina." Licentiate thesis, Växjö University, School of Health Sciences and Social Work, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:vxu:diva-7409.
Full textAbstract:
This thesis researches the phenomenon ‘caring relationship’. The empirical studies in this thesis were carried out in China with the aim to describe the caring relationship in China through the lifeworld experiences of professional caregivers and patients. The result of this study will later on relate to a study of Swedish caring relationships.
For this phenomenological study 9 patients, 10 medical and healthcare workers and 4 nursing tutors were interviewed. They were from 5 different medical and care units from two hospitals, one private clinic and a nursing school in Southern China.
This study shows that caring relationship in China has many layers. Embedded in the basic interpersonal relationship is a ‘relationship of need’. The relationship carries a goal: to help the patient to restore a personal harmonic existence and regain the responsibility for their health. The relationship is temporary and normally ends when the goal is achieved.
The relationship is initiated by the patients need for help. The two main actors in the caring relationship are the patient and the caregiver with their roles as care seeker and care provider. This study shows that to become a patient is a process of diminishing the natural ordinary self which makes the person feel vulnerable. Caregivers take a leading role which carries responsibility. They feel an obligation to use all their knowledge and resources for the benefit of the patients. They teach them how to live and how to stay healthy.
A main function in the caring relationship is the transfer of knowledge. The caregivers feel the need to create a dialog to get access to the patients’ unique knowledge about themselves so that the caregiver’s general knowledge of health and care can be applied to the individual. Through the informal chats they share the patient’s experiences, emotions and history. It creates en opportunity for the interpersonal relationship to grow deeper and for the patient and the caregiver to meet as fellow human beings.
In the Chinese caring relationship the patient’s family is included. It is considered to be every contributor’s duty to be responsible for oneself and for others. Mutual understanding and respect in a caring relationship are important in getting the patient back into balance.
3
Gobbetti, Gisele Joana. ""A função da confidencialidade: bioética e incesto"." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-11102006-104710/.
Full textAbstract:
O presente estudo pretende construir uma reflexão sobre a função da confidencialidade para os profissionais de saúde que lidam com pessoas envolvidas em casos de incesto, na tentativa de avaliar os limites éticos destas intervenções. A metodologia utilizada constituiu-se por uma reflexão teórica baseada na experiência de trabalho da autora no CEARAS, referendada pela Bioética e pela Psicanálise e ilustrada por uma pesquisa realizada com os profissionais de saúde, incluindo os médicos, enfermeiras, técnicas e auxiliares de enfermagem e assistentes sociais do Pronto-Atendimento Pediátrico do Hospital Universitário da Faculdade de Medicina da Universidade de São Paulo. Entrevistas livres de exploração sobre a possibilidade de atendimento a crianças e adolescentes com suspeitas de abuso sexual e o modo de lidar com estas questões foram realizadas com os profissionais. As entrevistas foram gravadas e transcritas para serem analisadas através do método de análise de conteúdo. O atendimento de pacientes envolvidos em situações de abuso sexual é considerado pelos profissionais de saúde como um problema de difícil abordagem. A ausência do conflito entre a quebra do segredo profissional e a manutenção do vínculo de confiança entre profissional de Saúde e paciente em situações de incesto demonstra a dificuldade de os profissionais lidarem com tais casos e discriminarem a função de um profissional de saúde, pelo incesto se tratar justamente do tabu estruturante do ser humano.This work intends to build up considerations about the confidentiality function for health professionals who deal with people involved in cases of incest, trying to evaluate the ethical limits of these interventions. The methodology used was a theoretical reflection based on Bioethics and Psychoanalyses and was illustrated by research with health professionals, including doctors, nurses, social workers and nurse assistants from Pediatric Emergency Room at University Hospital of São Paulo University. Free exploring interviews about the possibility of attending children and adolescents with suspects of sexual abuse and the way to deal professionally with such situation were conducted with those professionals. The interviews were recorded and transcribed for analysis through content analysis technique. The attendance of patients involved in sexual abuse situations is considered by health professionals as a difficult problem to approach. The absence of conflict between breaking professional secrecy and the maintenance of the reliance bond between the health professional and the patient on incest situations, shows the difficulties for the professionals to deal with people involved in those cases and, to discriminate the function of a health professional, by considering incest as a structuralizing taboo from the essence of human being.
4
Reversat, Bernard. "La réflexion éthique au service de l'analyse des pratiques professionnelles sur un territoire de santé." Thesis, Aix-Marseille, 2017. http://www.theses.fr/2017AIXM0621/document.
Full textAbstract:
Le sens de l’exercice soignant se fonde sur le “vivre ensemble” et se nourrit d’un important besoin de réflexion éthique que l’on retrouve tant chez les étudiants qu’auprès des professionnels de santé. Pour autant, l’exercice de la réflexion et le développement de la formation à l’éthique ont été peu présents en formation initiale et dans le parcours de la majorité des professionnels en activité. La posture individuelle réflexive ne suffit pas et doit être complétée par une démarche collective de réflexion éthique associant le patient, sa famille ou ses proches, au dialogue interdisciplinaire. La commission « éthique et professions de santé » (rapport A Cordier 2003) a identifié un manque de lieux et de temps pour les soignants, leur permettant de « formaliser » leur réflexion éthique. Cette thèse se propose d’identifier les dispositifs à construire, au travers de séquences de simulation en santé, afin d’accompagner les acteurs du soin dans cette démarche de questionnement à priori mais aussi à postériori,.Des questionnaires seront utilisés afin d’enrichir et de conforter l’hypothèse centrale.Un autre axe de recherche tentera d’objectiver les variations du niveau de pertinence des principes éthiques en jeu, en fonction des contextes et ceci au travers d’observations menées lors de réunions pluridisciplinaires, entre professionnels du soin..Enfin et en réponse à la question de départ, il apparait qu’un programme de Développement Professionnel Continu (DPC), conçu comme « nouvel espace de la réflexion » semble être une opportunité à saisir, pour aider les acteurs du soin à clarifier les situations et à construire en collégialité, le sens de leur pratiqueThe meaning of the nursing exercise is based on the notion of “living together” and feeds on an important need for ethical reflection both from students and healthcare professionals. However, the reflection exercise and the development of training in the field of ethics have been scarce in initial training and in the career path of most of professionals in service. The individual reflexive position is not sufficient and must be completed by a collective approach of ethical reflection in which the patient, his/her family or his/her close relations are associated with interdisciplinary dialogue. The “Ethics and Health Professions” committee (as per the A Cordier report in 2003) pointed out a lack of locations and time for the nursing staff, which could allow them to “formalize” their ethical reflection. This thesis suggests identifying the systems to be created in order, for example of the sequences of simulation in health, to accompany nursing players in this questioning approach a priori but also exposit. Questionnaires will be used to enhance and consolidate the main assumption. Another research focus will attempt to objectify changes in the level of relevance of ethical principles involved, according to contexts and through observations conducted during multidisciplinary meetings between health professionals. This approach will attempt to validate another hypothesis. Finally, to answer the initial question, it appears that a Continuous Professional Development program (DPC), designed as a “new area for reflection” seems to be an opportunity that must be seized, to help care providers to clarify situations et build their practice purpose in a collegial manner
5
"國內心理治療師對專業關係的理解與經驗初探." Thesis, 2009. http://library.cuhk.edu.hk/record=b6074731.
Full textAbstract:
Based on the above findings, the researcher has the following suggestions: (1) The use of therapeutic settings and therapeutic relationships in working with clients should be strengthened in education and continuous professional training for Chinese psychotherapists, especially to those who do not have educational background in medical science. Simultaneously, it is important to enhance the reflectivity of Chinese psychotherapists on their work and life experience. (2) To emphasize the legitimacy of psychotherapy in China, we have to regulate the norms of the profession according to the professional Code. Further, the principle of "do no harm" should be given higher priority in psychotherapy, psychotherapist need to cope with the demands from reality using wisdom and reason, pay attention to the affective needs of clients and promote social justice. (3) In the development of psychotherapy in mainland China, special efforts should be made to preserve the positive elements in traditional Chinese culture for the helping professions, keeping a balance between technical rationality and humane concern. We should pay attention to the goals of enhancing individual development, respect for diversity and importance of equality in practice as well as utilize the Chinese tradition and culture in helping clients to develop compassion, having empathetic understanding on the needs of one another. The purpose of doing so is to develop a new culture valuing compassion and reason in relating to one another.The major findings of this research are as follows. (1) The understanding on the role of the therapeutic settings by the therapists are different. In comparison, those with training in psychoanalysis tend to attach more importance on the role of therapeutic settings than those who do not have such training. (2) The mainland psychotherapists still emphasis the importance of affection in relating with clients, using special rather than standard treatment for particular clients, which may result from the "differential distance in interpersonal relationship" dominant in Chinese culture. (3) Professional ethics for communities of counseling practice is newly introduced into mainland China, and people are beginning to pay attention to its relevant ethics. Its development, however, is still in infancy stage. (4) The mainland Chinese psychotherapists emphasis more on building relationship with people than developing technical skills in psychotherapy. This may be related to the fact that Chinese culture attaches more importance to interpersonal relationships.
This research attempts to answer the following questions: (1) What are the understanding of mainland Chinese psychotherapists about the meaning of professional ethics and therapeutic relationships? (2) How do they establish therapeutic relationships with their clients? (3) Are there any patterns in their establishment of therapeutic relationships, and how they interpret these patterns? (4) In their views, what are the principles and main points in establishing a healthy therapeutic relationship?
This study has implications for the helping professions in mainland China that it reveals the experiences, feelings and cognition of some mainland Chinese psychotherapists in their embodied professional ethical norms and therapeutic relationships. It illustrates the characteristics of these psychotherapists in dealing with professional relationships in a country which still values relationships and human feelings. The study also examines the factors that have influenced these psychotherapists in the development of their characteristics, e.g. the country's history, modern cultural atmosphere, and the ordinary people's routine styles of interpersonal exchange in China. The findings of this study, as a preliminary exploration of the process of establishing ethical norms and principles in mainland China, would be helpful to the development of social work in mainland China. (Abstract shortened by UMI.)
This study is significant as it is the first qualitative inquiry of the therapeutic relationships between clients and psychotherapists in mainland China. It explores the the impact of Chinese cultural tradition and modern social development on the mentality of mainland Chinese psychotherapists.
Using social constructivism as the epistemological frame, ecological systems theory is chosen as the theoretical framework in conducting the study using qualitative research. In-depth interviews and on-site observations are the methods chosen to collect data. The main source of data comes from in-depth interviews with 15 psychotherapists in different institutes located in four cities in mainland China. Through careful analysis of the data, thick description is used to describe the data. And using thematic analysis for the interpretation of the findings.
陳向一.
Source: Dissertation Abstracts International, Volume: 71-01, Section: A, page: 0332.
Thesis (doctoral)--Chinese University of Hong Kong, 2009.
Includes bibliographical references (p. 277-300).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstracts in Chinese and English.
Chen Xiangyi.
6
Ramokgopa, Mmampapatla Thomas. "Repairing broken bones and broken promises: informed consent and orthopaedic practice in South Africa." Thesis, 2011. http://hdl.handle.net/10539/10586.
Full textAbstract:
The discipline of orthopaedic surgery is a fast growing surgical specialty directed at the diagnosis and management of disorders of the musculoskeletal system e.g. acute trauma, fractured or dislocated joints, elective reconstructive surgery as well as related research. The standard of care in orthopaedic surgery treatment reflects the status of its evolution and what is currently available in terms of the knowledge, surgical expertise, orthopaedic implant materials, and equipment.
It is the duty of the orthopaedic surgeon to live up to the promise as best he or she can to heal when it is possible to heal and to provide the level of care expected that transcends simple surgical expertise and bio-technological intervention.
The informed consent process is an often neglected but vital component of the standard of care which has to satisfy prescribed ethical and legal requirements. This research is focused on how to heighten the awareness of, and to encourage engagement within the orthopaedic surgery fraternity with the informed consent process. If the informed consent is given more recognition within this group, it will benefit the potentially vulnerable orthopaedic patient, protect the
orthopaedic surgeon against litigation, and importantly, contribute to the ethical imperatives bound in a doctor-patient relationship.
For this research, a vast search of the available local and international literature has been perused and my finding is that the application of Ethics and recognition of the informed consent concept within the medical community in general is gathering momentum and it must be both supported and internalized by those in orthopaedic surgical practice.
7
Anderson, Carita Michelle. "Managing feelings of sexual attraction in therapy an instructional program for therapists-in-training /." 2001. http://books.google.com/books?id=73NHAAAAMAAJ.
Full text
8
Kalaitzidis, Evdokia. "professional ethics for professional nursing." 2006. http://arrow.unisa.edu.au:8081/1959.8/30081.
Full textAbstract:
The thesis proposes and defends a maxim which can serve as a foundation and guideline for professional ethics in nursing, the maxim that nurses should act so far as possible to promote patient's self-determination. The thesis is informed by philosophical ethics and by knowledge of professional nursing practice.
9
Redwine, Erin Michelle. "The effects of children's age, gender and ethnicity on their preference of male or female health care providers from different ethnic groups a thesis submitted in partial fulfillment ... for the degree of Master of Science (Pediatric Dentistry) ... /." 1998. http://catalog.hathitrust.org/api/volumes/oclc/68891797.html.
Full textBooks on the topic "Professional-patient relations – ethics"
1
Stanford, Carla Caldwell. Ethics for health professionals. Burlington, MA: Jones & Bartlett Learning, 2013.
Find full text
2
Milgrom, Jeanette Hofstee. Boundaries in professional relationships: A training manual. Minneapolis, MN: Walk-in Counseling Center, 1992.
Find full text
3
Peterson, Marilyn R. At personal risk: Boundary violations in professional-client relationships. New York: Norton, 1992.
Find full text
4
Rutter, Peter. Sex in the forbidden zone: When men in power--therapists, doctors, clergy, teachers, and others--betray women's trust. Los Angeles: J.P. Tarcher, 1989.
Find full text
5
Strean, Herbert S. L'agir sexuel en thérapie: Traitement et réadaptation du thérapeute déviant. Montréal: Les Presses de l'Université de Montréal, 1998.
Find full text
6
Holland, Patricia M. Communication & ethics for bodywork practitioners. Philadelphia: F.A. Davis Co., 2012.
Find full text
7
Buerki, Robert A. Pharmacy ethics: A foundation for professional practice. Washington, D.C: American Pharmacists Association, 2013.
Find full text
8
Bissell, LeClair. Ethics for addiction professionals. Center City, MN: Hazelden Educational Materials, 1987.
Find full text
9
Gohsman, Robyn. Law and ethics. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009.
Find full text
10
Aiyegbusi, Anne, and Gillian Kelly. Professional and therapeutic boundaries in forensic mental health practice. London: Jessica Kingsley Publishers, 2012.
Find full textBook chapters on the topic "Professional-patient relations – ethics"
1
Wojciechowska, Nelosława. "Problem kodeksów etyki w ochronie zdrowia widziany z perspektywy refleksyjnego praktyka zarządzania." In Ochrona zdrowia i gospodarka. Przegląd współczesnych problemów systemu opieki zdrowotnej, 120–39. Wydawnictwa Uniwersytetu Warszawskiego, Sekcja Wydawnicza Wydziału Zarządzania UW, 2022. http://dx.doi.org/10.7172/978-83-235-5874-3.swwz.11.5.
Full textAbstract:
The purpose of this chapter was to critically analyze the codes of ethics of currently operating health care medical institutions in the state sector in Poland, as well as to identify appropriate solutions for their standardization in order to create a unified code of ethics that would combine the code of business ethics, the code of conduct for employees, the code of professional practice, the set of rights and duties into a whole, thus creating a basic mechanism to ensure full professionalism in their operation. This work analyzes, among other things, the existing rights and obligations of the patient, interpersonal staff/patient relations, standards of ethical behavior for management, and the issue of social responsibility. Unfortunately, the analysis is not detailed due to the small number of factual analyses and studies available, as well as the multifaceted nature of the subject matter, which requires effective communication-participation of all professional communities, a baseline analysis, knowledge of laws and regulations, estimation of risks, or knowledge of the industry and its market situation.
2
Bloche, M. Gregg. "Medical ethics in the courts." In Ethical Dimensions of Health Policy, 133–56. Oxford University PressNew York, NY, 2000. http://dx.doi.org/10.1093/oso/9780195140705.003.0008.
Full textAbstract:
Abstract Judges are America’s health policy makers of last resort. Ambiguous statutes and contract terms, legal challenges to administrative decisions, and gridlock in Congress and state legislatures give courts a large role by default in the governance of health-care provision. Judges with cursory understandings of the ethics and economics of medical care define the environment within which market forces operate. In so doing, courts answer questions of distributive justice, disclosure and consent, and professional duty that are staples of medical ethics discussion. The managed care revolution has deepened judges’ engagement in matters at the heart of medical ethics discourse about the doctor-patient relationship and the role of the market. Health plans routinely seek to manage costs by influencing physicians’ clinical judgments and recommendations. Financial rewards for limiting care, prior authorization requirements, clinical practice protocols, and practice profiling aimed at identifying (and discouraging) high-cost providers are among the methods that spark legal conflict concerning the governance of doctor-patient relations and the appropriate scope of the market paradigm.
3
Hain, Richard D. W. "Ethics in paediatric palliative care." In Oxford Textbook of Palliative Medicine, edited by Nathan I. Cherny, Marie T. Fallon, Stein Kaasa, Russell K. Portenoy, and David C. Currow, 1155–60. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198821328.003.0109.
Full textAbstract:
Professional competence is a necessary but insufficient representation of how an individual healthcare professional should properly behave in relation to a patient. Medical ethics addresses the further question of how to decide what actions taken by professionals in the context of that relationship are morally right. The ways in which children are distinct from adults are relevant to that question. Children are part of a family, their autonomy is limited in principle—and even more in practice—and, because they are often unable to communicate, children’s interests are easily ignored or annexed to others. The two ways in which ethical questions are currently usually addressed in practice are by appealing to principlism or to rights-based arguments. The ethical theories behind those approaches (deontology, utilitarian consequentialism, and virtue ethics) are problematic in children. While all are helpful, none provides a comprehensive or consistent account that is both ethically argued and child specific. This chapter reviews the strengths and weaknesses of existing ways of looking at ethics in end of life care for children and considers two important, specific, contemporary ethical debates in medical ethics in children’s palliative care: the principle of double effect and withholding or withdrawal of life-sustaining treatment.
4
Bloch, Sidney, and Stephen A. Green. "The scope of psychiatric ethics." In Psychiatric Ethics, edited by Sidney Bloch and Stephen A. Green, 3–10. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198839262.003.0001.
Full textAbstract:
Ethical decision-making is no easy matter, as absolutes of right and wrong, good and bad, should and ought, and other evaluative terms are elusive. Both providing the best attainable care for the patient and conducting scientific research guided by lofty ethical principles are paramount. This chapter, an introduction to the fifth edition of Psychiatric Ethics, outlines how the book aims to promote the moral agency of psychiatrists and mental health professionals when relating to patients and their families, colleagues, professional associations, and other organizations, and the society in which they work. It summarizes theoretical frameworks used in ethical decision-making and the range of topics discussed in the other 24 chapters, and offers guidelines to mental health students and graduate clinicians about how to master the field of ethics in psychiatry.
5
Ida Christi, V. E. "ETHICAL ISSUES IN PHARMACIST PATIENT RELATIONSHIP." In Futuristic Trends in Pharmacy & Nursing Volume 3 Book 1, 12–26. Iterative International Publishers, Selfypage Developers Pvt Ltd, 2024. http://dx.doi.org/10.58532/v3bipn1p1ch2.
Full textAbstract:
Pharmacists universally emphasized the ethical challenges associated with pharmacy practice and consultation, which encompass professional obligations, dispensing medications, addressing medication errors, and handling conflicts of interest. Dealing with noncompliant patients who refuse medication due to adverse effects presents multifaceted ethical dilemmas for pharmacists. It is evident that pharmacists must consistently demonstrate empathy, promote patient autonomy, and exhibit compassion when interacting with such patients. The patient's trust in their pharmacist constitutes a crucial element in the patient-pharmacist relationship. As patient well-being is one of the fundamental principles of pharmacy practice, the pharmacist's ultimate goal is to ensure that the patient achieves the maximum therapeutic benefit from their medication while alleviating the patient's health-related concerns. Ethical challenges arise in scenarios involving drug shortages, counterfeit medications, addressing patient requests for medication returns, and providing prescription drugs without a physician's order. The most effective approach to resolving these ethical dilemmas involves pharmacists adhering to the Code of Ethics for Pharmacists, earning the trust and cooperation of the patient, and taking the necessary time to educate the patient about their chronic illness and the importance of adhering to their maintenance medication regimen. This chapter discuss about the ethical issues and challenges of the pharmacist in relation with patients, also how to overcome the issues.
6
Iserson, Kenneth V., and Bruce E. Jarrell. "Financial Relationships With Patients." In Surgical Ethics, 322–41. Oxford University PressNew York, NY, 1998. http://dx.doi.org/10.1093/oso/9780195103472.003.0017.
Full textAbstract:
Abstract Medical finances and bioethics seem to be both worlds apart and intricately intertwined. Purists claim that many issues relating money to medical practice are questions of professional etiquette rather than ethical issues. Yet within the medical profession, questions of reimbursement, payment mechanisms, and conflicts of interest have stimulated useful ethical discussions and guidelines since ancient times. As health care delivery systems and medical care itself evolves, surgeons’ relationships with their patients will require even more ethical direction than this chapter describes. Reimbursement asan Ethical Issue. It is appropriate for medical ethics to concern itself with the business aspects of medicine, and particularly with the surgeon’s reimbursement for rendered services. Many patients believe that their doctors are more concerned about making money than with patient well-being.
7
Glas, Gerrit. "A Normative Practice Approach to Health Care." In The Normative Nature of Social Practices and Ethics in Professional Environments, 164–84. IGI Global, 2019. http://dx.doi.org/10.4018/978-1-5225-8006-5.ch008.
Full textAbstract:
This chapter explains how and why healthcare might profit from a normative practice approach (NPA). This approach sketches a conceptual and normative framework that helps to locate and identify relevant points of view for clinical practice as well as for policy making in healthcare. The chapter starts in medias res: in the consulting room, in the encounter between clinician and patient. What kinds of relations are relevant for the understanding of what is going in the patient who feels ill and between the patient and the doctor (or nurse)? Are there normative principles and values which guide these relationships? The focus then broadens to the meso- and macro-contexts of current medicine and healthcare. The NPA will be re-introduced. Its relevance is shown for topics like the increase in the administrative burden in medicine, the role of expert knowledge, the hospital and its purposes, and the changing focus of medicine given the rapid changes in the macro-sphere. The chapter ends by saying that the NPA may help in different ways: by taking it as a point of reference; by relating the different normative dimensions to core responsibilities of doctors, other employees, and stakeholders beside medical professionals; and by relating these core responsibilities to the relevant contexts in which these doctors, other employees, and stakeholders are working.
8
Farrell, A. M., and E. S. Dove. "8. Consent to Medical Treatment." In Mason and McCall Smith's Law and Medical Ethics, 218–48. Oxford University Press, 2023. http://dx.doi.org/10.1093/he/9780192866226.003.0008.
Full textAbstract:
This chapter explores the nature of consent to medical treatment for adults (primarily those with capacity), as well as its flipside, refusal of medical treatment. We begin by focusing on the function of consent and the consequences for failing to obtain it. We then consider what constitutes informed consent for the purposes of medical treatment, and the nature of information which must be disclosed to a patient to secure this. Finally, we discuss circumstances where medical treatment may proceed even in the absence of consent. As part of this, the chapter traces the history of ‘informed consent’ from the American case of Salgo (1957) through and beyond the foundational UK Supreme Court case of Montgomery v Lanarkshire Health Board (2015), which sets out legal rules on the disclosure of risks to satisfy the criteria of an informed consent for medical treatment. We discuss how patient autonomy and exercise of choice is now a common theme in relevant case law, and professional guidance increasingly emphasises shared decision making for treatment decisions. Nevertheless, the law still places hurdles in the path of individuals seeking to exercise their autonomy, and vestiges of Bolam (1957) remain, particularly in relation to medical advice concerning the risks associated with treatment.
9
Flynn, Maria, and Dave Mercer. "Surgery." In Oxford Handbook of Adult Nursing, edited by Maria Flynn and Dave Mercer, 441–62. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198743477.003.0022.
Full textAbstract:
When working with people who are having any type of surgery, the primary nursing responsibility is minimizing risk and maintaining patient safety. Nurses should always act within the limits of their knowledge, skills, and competence. All nursing decision-making in relation to surgery is framed by legal and ethical considerations, professional values, and teamwork, and grounded in respectful, appropriate communication skills. Anaesthetics, recovery, and operating departments are specialized areas of nursing practice, but general adult nurses will be involved in preparing people for surgery and in supporting them after their operation until they are discharged from hospital. All organizations will have policies and procedures for surgical safety, and it is incumbent on nurses to operate within local requirements. This chapter describes generic principles of safe surgery and surgical nursing practices.
10
McKnight, Rebecca, Jonathan Price, and John Geddes. "Communicating your findings." In Psychiatry. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198754008.003.0015.
Full textAbstract:
The first part of this chapter offers guidance on how to explain to patients and their carers the results of your assessment. The second part of this chapter offers guidance on communicating with other healthcare professionals, which is a vital part of modern healthcare: no longer can one nurse or one doctor, working in geographical and professional isolation, seek to deliver effective health interventions to a population. Instead, healthcare is delivered in complex systems, integrating primary, secondary, and tertiary care; different medical specialties; and different disciplines, such as doctors, nurses, psychologists, and occupational and physiotherapists. Interviewers should be aware of the ethical and legal principles that govern the giving of information to people other than the patient. These principles are summarized in Box 10.1. Sometimes a relative or another person telephones the interviewer to ask for information about the patient. In general, the patient should be told of the request, and asked whether or not they are happy to give their permission. The clinician should never allow a conspiratorial atmosphere to develop in which he or she conceals from the patient conversations with family, friends, or others. Patients and relatives need to know more than the diagnosis and the basic facts about treatment. It is useful to begin by finding out what they know already, and what help they are expecting. This information makes it easier to meet their requirements, help with their concerns, and explain the treatment plan. It is useful to keep in mind the list of frequently asked questions shown in Box 10.2. The management plan should be explained using the usual principles of patient communication such as: … ● delivering information in an unhurried way; ● avoiding jargon; ● checking from time to time that the patient has understood; ● involving a relative/ carer whenever possible and permitted by the patient; ● encouraging questions; ● summarizing the plan in writing (e.g. in a subsequent letter). If, after a full discussion, the patient does not accept some part of the plan, or the relatives do not accept the role proposed for them, a compromise should be negotiated.
Conference papers on the topic "Professional-patient relations – ethics"
1
Cordero-Díaz, MA, and MP González-Amarante. "HUMANISM IN TIMES OF PANDEMIC: ONLINE CLINICAL SIMULATION FOR THE DEVELOPMENT OF ETHICAL COMPETENCIES." In The 7th International Conference on Education 2021. The International Institute of Knowledge Management, 2021. http://dx.doi.org/10.17501/24246700.2021.7113.
Full textAbstract:
The SARS-COV2 health contingency and the cessation of face-to-face activities has motivated multiple educational innovations for distance teaching. Medical schools are particularly defied because of the need for clinical training, however simulation offers opportunities to achieve continuity. A clinical simulation exercise was redesigned and transformed to an online synchronic simulation via Zoom. The participating groups of medical students (n=53) were in the Bioethics and Clinical Bioethics courses, adjunct to their Pediatrics and Obstetrics and Gynecology (ObGyn) clerkships in June 2020. Two simulated clinical cases were performed via Zoom, followed by a debriefing session. Later, an online survey was applied to the participants to know their perception and experience with this new version, considering they had experienced the original face-toface simulation on the alternate clerkship the prior trimester. A mixed method approach was used to analyze the responses. The results showed that the virtual format was very effective, 72% considered it very similar to the original version. The exercise revealed high emotional commitment, allowing students to develop their socio-emotional skills. Student reactions were categorized and coded as emotions triggered by a) their performance as professionals, b) those related directly to the patient’s emotions and situation, which showed significant gender differences, and c) students' anxiety related to the academic exercise itself, the least found. The fact that the clinical component was restructured due to the remote format may have helped in focusing on the preponderance of emotional, communication and relational aspects of the patient-doctor relationship. Also, most students identified the exercise was meaningful in approaching bioethics contents, including end-of-life decisions in patient care, and informed consent. In conclusion, the online clinical simulation activity proved effective in integrating professionalism outcomes that encompass ethical knowledge, skills and attitudes that prepare medical students for their professional role, along with the debriefing reinforcing insightful learning integration. Keywords: educational innovation, higher education, clinical simulation, humanism, ethics
Reports on the topic "Professional-patient relations – ethics"
1
Tipton, Kelley, Brian F. Leas, Emilia Flores, Christopher Jepson, Jaya Aysola, Jordana Cohen, Michael Harhay, et al. Impact of Healthcare Algorithms on Racial and Ethnic Disparities in Health and Healthcare. Agency for Healthcare Research and Quality (AHRQ), December 2023. http://dx.doi.org/10.23970/ahrqepccer268.
Full textAbstract:
Objectives. To examine the evidence on whether and how healthcare algorithms (including algorithm-informed decision tools) exacerbate, perpetuate, or reduce racial and ethnic disparities in access to healthcare, quality of care, and health outcomes, and examine strategies that mitigate racial and ethnic bias in the development and use of algorithms. Data sources. We searched published and grey literature for relevant studies published between January 2011 and February 2023. Based on expert guidance, we determined that earlier articles are unlikely to reflect current algorithms. We also hand-searched reference lists of relevant studies and reviewed suggestions from experts and stakeholders. Review methods. Searches identified 11,500 unique records. Using predefined criteria and dual review, we screened and selected studies to assess one or both Key Questions (KQs): (1) the effect of algorithms on racial and ethnic disparities in health and healthcare outcomes and (2) the effect of strategies or approaches to mitigate racial and ethnic bias in the development, validation, dissemination, and implementation of algorithms. Outcomes of interest included access to healthcare, quality of care, and health outcomes. We assessed studies’ methodologic risk of bias (ROB) using the ROBINS-I tool and piloted an appraisal supplement to assess racial and ethnic equity-related ROB. We completed a narrative synthesis and cataloged study characteristics and outcome data. We also examined four Contextual Questions (CQs) designed to explore the context and capture insights on practical aspects of potential algorithmic bias. CQ 1 examines the problem’s scope within healthcare. CQ 2 describes recently emerging standards and guidance on how racial and ethnic bias can be prevented or mitigated during algorithm development and deployment. CQ 3 explores stakeholder awareness and perspectives about the interaction of algorithms and racial and ethnic disparities in health and healthcare. We addressed these CQs through supplemental literature reviews and conversations with experts and key stakeholders. For CQ 4, we conducted an in-depth analysis of a sample of six algorithms that have not been widely evaluated before in the published literature to better understand how their design and implementation might contribute to disparities. Results. Fifty-eight studies met inclusion criteria, of which three were included for both KQs. One study was a randomized controlled trial, and all others used cohort, pre-post, or modeling approaches. The studies included numerous types of clinical assessments: need for intensive care or high-risk care management; measurement of kidney or lung function; suitability for kidney or lung transplant; risk of cardiovascular disease, stroke, lung cancer, prostate cancer, postpartum depression, or opioid misuse; and warfarin dosing. We found evidence suggesting that algorithms may: (a) reduce disparities (i.e., revised Kidney Allocation System, prostate cancer screening tools); (b) perpetuate or exacerbate disparities (e.g., estimated glomerular filtration rate [eGFR] for kidney function measurement, cardiovascular disease risk assessments); and/or (c) have no effect on racial or ethnic disparities. Algorithms for which mitigation strategies were identified are included in KQ 2. We identified six types of strategies often used to mitigate the potential of algorithms to contribute to disparities: removing an input variable; replacing a variable; adding one or more variables; changing or diversifying the racial and ethnic composition of the patient population used to train or validate a model; creating separate algorithms or thresholds for different populations; and modifying the statistical or analytic techniques used by an algorithm. Most mitigation efforts improved proximal outcomes (e.g., algorithmic calibration) for targeted populations, but it is more challenging to infer or extrapolate effects on longer term outcomes, such as racial and ethnic disparities. The scope of racial and ethnic bias related to algorithms and their application is difficult to quantify, but it clearly extends across the spectrum of medicine. Regulatory, professional, and corporate stakeholders are undertaking numerous efforts to develop standards for algorithms, often emphasizing the need for transparency, accountability, and representativeness. Conclusions. Algorithms have been shown to potentially perpetuate, exacerbate, and sometimes reduce racial and ethnic disparities. Disparities were reduced when race and ethnicity were incorporated into an algorithm to intentionally tackle known racial and ethnic disparities in resource allocation (e.g., kidney transplant allocation) or disparities in care (e.g., prostate cancer screening that historically led to Black men receiving more low-yield biopsies). It is important to note that in such cases the rationale for using race and ethnicity was clearly delineated and did not conflate race and ethnicity with ancestry and/or genetic predisposition. However, when algorithms include race and ethnicity without clear rationale, they may perpetuate the incorrect notion that race is a biologic construct and contribute to disparities. Finally, some algorithms may reduce or perpetuate disparities without containing race and ethnicity as an input. Several modeling studies showed that applying algorithms out of context of original development (e.g., illness severity scores used for crisis standards of care) could perpetuate or exacerbate disparities. On the other hand, algorithms may also reduce disparities by standardizing care and reducing opportunities for implicit bias (e.g., Lung Allocation Score for lung transplantation). Several mitigation strategies have been shown to potentially reduce the contribution of algorithms to racial and ethnic disparities. Results of mitigation efforts are highly context specific, relating to unique combinations of algorithm, clinical condition, population, setting, and outcomes. Important future steps include increasing transparency in algorithm development and implementation, increasing diversity of research and leadership teams, engaging diverse patient and community groups in the development to implementation lifecycle, promoting stakeholder awareness (including patients) of potential algorithmic risk, and investing in further research to assess the real-world effect of algorithms on racial and ethnic disparities before widespread implementation.