Hospital ethics reflection groups: a learning and development resource for clinical practice

Abstract Background An ethics reflection group (ERG) is one of a number of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the significance of ERGs in psychiatric and general hospital departments in Denmark. Methods This is a qualitative action research study, including systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. Short written descriptions of the ethical challenges presented in the ERGs also informed the analysis of significance. Results A recurring ethical challenge for clinicians, in a total of 63 cases described and assessed in 3 ethical reflection groups, is to strike a balance between respect for patient autonomy, paternalistic responsibility, professional responsibilities and institutional values. Both in psychiatric and general hospital departments, the study participants report a positive impact of ERG, which can be divided into three categories: 1) Significance for patients, 2) Significance for clinicians, and 3) Significance for ward managers. In wards characterized by short-time patient admissions, the cases assessed were retrospective and the beneficiaries of improved dialogue mainly future patients rather than the patients discussed in the specific ethical challenge presented. In wards with longer admissions, the patients concerned also benefitted from the dialogue in the ERG. Conclusion This study indicates a positive significance and impact of ERGs; constituting an interdisciplinary learning resource for clinicians, creating significance for themselves, the ward managers and the organization. By introducing specific examples, this study indicates that ERGs have significance for the patients discussed in the specific ethical challenge, but mostly indirectly through learning among clinicians and development of clinical practice. More research is needed to further investigate the impact of ERGs seen from the perspectives of patients and relatives.

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How to succeed with ethics reflection groups in community healthcare? Professionals’ perceptions

Nursing Ethics ◽

10.1177/0969733017747957 ◽

2018 ◽

Vol 26 (4) ◽

pp. 1243-1255 ◽

Cited By ~ 3

Author(s):

Heidi Karlsen ◽

Lillian Lillemoen ◽

Morten Magelssen ◽

Reidun Førde ◽

Reidar Pedersen ◽

...

Keyword(s):

Organizational Support ◽

Reflection Group ◽

Healthcare Services ◽

Healthcare Personnel ◽

Success Factor ◽

Ethical Challenges ◽

Reflection Groups ◽

Community Healthcare ◽

Group Interviews ◽

Ethics Reflection

Background: Healthcare personnel in the municipal healthcare systems experience many ethical challenges in their everyday work. In Norway, 243 municipalities participated in a national ethics project, aimed to increase ethical competence in municipal healthcare services. In this study, we wanted to map out what participants in ethics reflection groups experienced as promoters or as barriers to successful reflection. Objectives: To examine what the staff experience as promoters or as barriers to successful ethics reflection. Research design: The study has a qualitative design, where 56 participants in municipal healthcare participated in 10 different focus-group interviews. Ethical considerations: The data collection was based on the participants’ informed consent and approved by the Data Protection Official of the Norwegian Centre for Research Data. Results: The informants had different experiences from ethics reflection group. Nevertheless, we found that there were several factors that were consistently mentioned: competence, facilitator’s role, ethics reflection groups organizing, and organizational support were all experienced as promoters and as a significant effect on ethics reflection groups. The absence of such factors would constitute important barriers to successful ethics reflection. Discussion: The results are coincident with other studies, and indicate some conditions that may increase the possibility to succeed with ethics reflection groups. A systematic approach seems to be important, the systematics of the actual reflections, but also in the organization of ethics reflection group at the workplace. Community healthcare is characterized by organizational instabilities as many vacancies, high workloads, and lack of predictability. This can be a hinder for ethics reflection group. Conclusion: Both internal and external factors seem to influence the organization of ethics reflection group. The municipalities’ instabilities challenging this work, and perceived as a clear inhibitor for the development. The participants experienced that the facilitator is the most important success factor for establishing, carrying out, and to succeed with ethics reflection groups.

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Two Years of Ethics Reflection Groups About the Use of Coercion. Changes Over Time in Employees’ Normative Attitudes Regarding the Use of Coercion, User Involvement, Team Cooperation and the Handling of Disagreement

10.21203/rs.3.rs-133457/v1 ◽

2020 ◽

Author(s):

Bert Molewijk ◽

Reidar Pedersen ◽

Almar Kok ◽

Reidun Førde ◽

Olaf Aasland

Keyword(s):

Clinical Practice ◽

Evaluation Studies ◽

User Involvement ◽

Reflection Groups ◽

Team Cooperation ◽

Critical Attitude ◽

Changes Over Time ◽

The Impact ◽

Over Time ◽

Ethics Reflection

Abstract Background: Research on the impact of ethics reflection groups (ERG) or moral case deliberations (MCD) is complex and scarce. Within a larger study, ERG has been used as an intervention for stimulating critical ethical reflection and improved team cooperation while observing changes over time.Research question: Are there – during and after two years of ERGs - changes over time regarding employees’ normative attitudes regarding the use of coercion and how employees perceive user involvement, team cooperation and the handling of disagreement in teams?Methods: Repeated cross-sectional survey to multidisciplinary employees at seven wards within three Norwegian mental health care institutions (T0-T1-T2). Changes in normative attitudes over time were estimated using linear mixed models.Results: In total, 817 surveys (from employees that did and did not participate in ERG) were included in the analyses. Of these, 7.6 % (N=62) responded at all three points in time, 15.5% (N=127) at two points, and 76.8 % (N= 628) once. On average, over time, respondents who participated in ERG agreed less that coercion can be seen a form of care or security. ERG participants more often reported that they involved users and that they handled disagreement within the team constructively. Furthermore, more frequent ERG participation was associated with a more critical attitude towards coercion and higher scores for user involvement, the coercion competence of the team and the constructive handling of disagreement within their teams.Conclusions: Structural ERGs or MCDs seem to contribute to employees reporting a more critical attitude towards coercion, more user involvement around coercion and a more constructive handling of disagreement. Differences were generally small in absolute terms possibly due to the low amount of longitudinal data and the relative low frequency of ERG’s during the two years. Studying changes over time in clinical practice and trying to find a relationship between CES interventions and CES outcomes is difficult yet important and needs to be further developed in future CES evaluation studies. This explorative quantitative study may be a first step from qualitative evidence towards more robust quantitative evidence of the contribution of CES to clinical practice and quality of care.

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Harnessing AI for health equity in oncology research and practice.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.67 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 67-67

Author(s):

Alexandra Urman ◽

Ching-Kun Wang ◽

Irene Dankwa-Mullan ◽

Ethan Scheinberg ◽

Michael J. Young

Keyword(s):

Clinical Practice ◽

Health Equity ◽

Cancer Susceptibility ◽

Care Delivery ◽

Diagnostic Errors ◽

Ethical Challenges ◽

Ethical Implications ◽

Oncology Research ◽

Oncology Care ◽

The Impact

67 Background: Recent advances in artificial intelligence (AI) carry underexplored practical and ethical implications for the practice of clinical oncology. As oncologic applications of AI proliferate, a framework for guiding their ethical implementations and equitable distribution will be crucial. Methods: We reviewed the current landscape of AI applications in oncology research and clinical practice by reviewing the current body of evidence in PubMed and Medline. Key ethical challenges and opportunities to address health equity are critically evaluated and highlighted. Ethical implications for patients, clinicians and society at large are delineated, with particular focus on the impact and ramifications of AI with respect to healthcare disparities and equity of oncology care delivery. Results: Growing concerns that AI may widen disparities in oncologic care by virtue of lack of affordability, inconsistent accessibility and biased machine-learning models are addressed. Although there is potential for AI to widen disparities in oncology care, using foresight in application, AI has the potential to (1) democratize access to specialized clinical knowledge, (2) improve the accuracy of predicting cancer susceptibility, recurrence and mortality, (3) prevent diagnostic errors in under-resourced settings, (4) minimize unintended bias and (5) enable access to tailored therapeutic options including clinical trials if appropriately deployed. Separately, AI can be harnessed to identify areas of underserved needs and optimize systems of health-information sharing and reimbursements as blockchain technology converges with AI. As AI advances it will have a larger presence in oncology research and clinical practice. Conclusions: A strategic framework integrating ethical standards and emphasizing equitable implementation can help ensure that the potential of AI to address disparities in oncology are maximally captured and its perils averted. Further work is being done on exploring these challenges and will be submitted as a manuscript.

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Ethical challenges in palliative sedation of adults: protocol for a systematic review of current clinical practice guidelines

10.21203/rs.3.rs-1170023/v1 ◽

2021 ◽

Author(s):

Martyna TOMCZYK ◽

Cécile JAQUES ◽

Ralf J. JOX

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Positive Impact ◽

Grey Literature ◽

Palliative Sedation ◽

Current Clinical Practice ◽

Ethical Challenges

Abstract Introduction: This study aims to identify the full spectrum of ethical challenges of all forms of palliative sedation for adults as presented in current clinical practice guidelines (CPGs), and to determine whether CPGs specify ethical challenges of this therapy for cancer and non-cancer patients and, if so, how exactly they do this. To the best of our knowledge, no studies have yet investigated this topic. The purpose is purely descriptive; our aim is not to make any kind of normative judgements on these challenges. Nor is our aim to assess the quality of the CPGs. Methods and analysis : We will perform a systematic review of CPGs on palliative sedation for adults via five electronic databases, grey literature search tools, citation tracking, and contact with palliative care experts. Current CPGs validated by an international, national, or regional authority, published in English, German, French, Italian, or Polish, from 2000 to the date of the search, will be subjected to content analysis at the textual, linguistic, and thematic levels. This study protocol is reported in accordance with the PRISMA-P criteria and registered on PROSPERO. Discussion The results of our systematic review can help raise awareness and understanding of the complexity of ethical problems, rigorously guide reflection in this field, and be useful in elaborating ethical guidelines in an interdisciplinary approach, in order to have a positive impact on the quality of patient care, education and training, and research in respect of this complex and challenging practice.

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The Impact Of Internship Programme And Its Effects On The Physiotherapy Practice In Nigeria

Nigerian Journal of Medical Rehabilitation ◽

10.34058/njmr.v11i2.23 ◽

2007 ◽

Author(s):

Ayodele Teslim Onigbinde

Keyword(s):

Clinical Practice ◽

Clinical Training ◽

Positive Impact ◽

Training Programme ◽

Working Environment ◽

University Teaching ◽

Teaching Hospitals ◽

One Year ◽

The Impact ◽

Internship Training

Background: The recent introduction of one year internship training programme is one of the few steps taken to update standard and knowledge of upcoming physiotherapists in Nigeria. It is a compulsory one-year clinical training post-graduation from the university under the supervision of the clinicians. The major importance of introducing the new policy is to promote acquisition and utilization of new skills, and as well, develop skills and confidence already acquired during undergraduate days. Objectives: The aim of this study was to assess and evaluate the new internship-training programme considering welfare package like salary and wages, accommodation, employment opportunities, acceptability and working environment. The study also evaluated the opinion of the supervisors on the impact of the new policy on the profession, government and clinical practice. Method: Structured copies of self-administered questionnaires were distributed to forty-four interns at three accredited University Teaching Hospitals in Nigeria while 30 questionnaires were distributed to supervising physiotherapists in these hospitals. The response rate for interns was 100% while it was 60% for the supervisors. The data obtained from the designed questionnaire were analyzed by descriptive analysis. Results: The result showed that the 52% of the interns were satisfied with the support from their senior colleagues, work load (80%), freedom to plan and manage patients (100%), and supervision from senior colleagues (62%). They were grossly dissatisfied with their salaries (91%), equipment available (79%), pattern of conducting ward rounds (89%), and office environment (58%). The result also revealed that all the supervising physiotherapists (100%) were satisfied with the skill and clinical practice of the interns. The result further showed that the programme has a positive impact in terms of clinical practice, confidence employment opportunity, productivity and government policy (66–100%). Conclusion: This study concluded that the internship programme has a remarkable positive impact on the profession of physiotherapy in Nigeria. However, the intern physiotherapists were not satisfied most especially with their monthly income and pattern of conducting clinical rounds. KEY WORDS: Physiotherapy Internship Programme, Nigerian Physiotherapists.

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Measuring the Impact of an Open Online Prescribing Data Analysis Service on Clinical Practice: a Cohort Study in NHS England Data

10.1101/306415 ◽

2018 ◽

Author(s):

Alex J Walker ◽

Helen J Curtis ◽

Richard Croker ◽

Seb Bacon ◽

Ben Goldacre

Keyword(s):

Clinical Practice ◽

Confidence Interval ◽

Fixed Effects ◽

Positive Impact ◽

Fixed Effects Model ◽

Practice Level ◽

Prescribing Quality ◽

Two Measures ◽

Clinically Significant ◽

The Impact

AbstractBackgroundOpenPrescribing is a freely accessible service that enables any user to view and analyse NHS primary care prescribing data at the level of individual practices. This tool is intended to improve the quality, safety, and cost-effectiveness of prescribing.ObjectivesWe set out to measure the impact of OpenPrescribing being viewed on subsequent prescribing.MethodsHaving pre-registered our protocol and code, we measured three different metrics of prescribing quality (mean percentile across 34 existing OpenPrescribing quality measures, available “price-per-unit” savings, and total “low-priority prescribing” spend) to see if they changed after CCG and practice pages were viewed. We also measured whether practices whose data were viewed on OpenPrescribing differed in prescribing, prior to viewing, to those who were not. We used fixed effects and between effects linear panel regression, to isolate change over time and differences between practices respectively. We adjusted for month of prescribing in the fixed effects model, to remove underlying trends in outcome measures.ResultsWe found a reduction in available price-per-unit savings for both practices and CCGs after their pages were viewed. The saving was greater at the practice level (−£40.42 per thousand patients per month, 95% confidence interval −54.04 to −26.01) than at CCG level (−£14.70 per thousand patients per month, 95% confidence interval −25.56 to −3.84). We estimate a total saving since launch of £243k at practice level and £1.47m at CCG level between the feature launch and end of follow-up (August to November 2017) among practices viewed. If the observed savings from practices viewed were extrapolated to all practices, this would generate £26.8m in annual savings for the NHS, approximately 20% of the total possible savings from this method. The other two measures were not different after CCGs/practices were viewed. Practices which were viewed had worse prescribing quality scores overall, prior to viewing.ConclusionsWe found a clinically significant positive impact from use of OpenPrescribing, specifically for the class of savings opportunities that can only be identified by using this tool. We also show that it is possible to conduct a robust analysis of the impact of such an online service on clinical practice.

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Mental healthcare clinician engagement with point of care testing; a qualitative study

BMC Psychiatry ◽

10.1186/s12888-021-03067-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Joseph Butler ◽

Simone de Cassan ◽

Phil Turner ◽

Belinda Lennox ◽

Gail Hayward ◽

...

Keyword(s):

Mental Health ◽

Clinical Practice ◽

Mental Health Professionals ◽

Positive Impact ◽

Point Of Care ◽

Mental Healthcare ◽

Successful Implementation ◽

Point Of Care Testing ◽

Structured Interviews ◽

The Impact

Abstract Background Point of Care Testing (POCT) is being increasingly used to augment the delivery of physical health care in a variety of settings, but their use in mental health has been limited. Research into understanding the barriers faced for successful implementation of POCT in these settings is lacking. We aimed to identify factors affecting engagement and implementation of POCT within mental health teams by exploring the attitudes to POCT, and the perceived impact POCT has on the practice of mental healthcare clinicians. Methods Alongside a study evaluating the impact of a point of care device in Community Mental Health Teams (CMHTs), qualitative interviews were carried out with CMHT clinicians using POCT as part of annual physical checks for patients with severe and enduring mental illness. Data were collected using semi-structured interviews and analysed using thematic analysis. Results Fifteen clinicians were interviewed across a range of professional backgrounds. Clinicians identified usability of the technology, positive impact on their patient’s experience and improved self-efficacy as drivers for successful implementation of POCT into their clinical practice. Issues with device functioning and the potential for a negative effect on the therapeutic relationship with their patients were identified as barriers. Level of physical heath training was not found to be a barrier by mental health professionals to using POCT. Conclusions Understanding barriers and drivers for engagement is important to allow co-production of POCT and guidelines to facilitate introduction of POCT into routine clinical practice.

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Measuring the Impact of an Open Web-Based Prescribing Data Analysis Service on Clinical Practice: Cohort Study on NHS England Data (Preprint)

10.2196/preprints.10929 ◽

2018 ◽

Author(s):

Alex J Walker ◽

Helen J Curtis ◽

Richard Croker ◽

Seb Bacon ◽

Ben Goldacre

Keyword(s):

Clinical Practice ◽

Fixed Effects ◽

Positive Impact ◽

Fixed Effects Model ◽

Web Based ◽

Practice Level ◽

Prescribing Quality ◽

Two Measures ◽

The Impact

BACKGROUND OpenPrescribing is a freely accessible service that enables any user to view and analyze the National Health Service (NHS) primary care prescribing data at the level of individual practices. This tool is intended to improve the quality, safety, and cost-effectiveness of prescribing. OBJECTIVE We aimed to measure the impact of OpenPrescribing being viewed on subsequent prescribing. METHODS Having preregistered our protocol and code, we measured three different metrics of prescribing quality (mean percentile across 34 existing OpenPrescribing quality measures, available “price-per-unit” savings, and total “low-priority prescribing” spend) to see whether they changed after the viewing of Clinical Commissioning Group (CCG) and practice pages. We also measured whether practices whose data were viewed on OpenPrescribing differed in prescribing, prior to viewing, compared with those who were not. We used fixed-effects and between-effects linear panel regression to isolate change over time and differences between practices, respectively. We adjusted for the month of prescribing in the fixed-effects model to remove underlying trends in outcome measures. RESULTS We found a reduction in available price-per-unit savings for both practices and CCGs after their pages were viewed. The saving was greater at practice level (−£40.42 per thousand patients per month; 95% CI −54.04 to −26.81) than at CCG level (−£14.70 per thousand patients per month; 95% CI −25.56 to −3.84). We estimate a total saving since launch of £243 thosand at practice level and £1.47 million at CCG level between the feature launch and end of follow-up (August to November 2017) among practices viewed. If the observed savings from practices viewed were extrapolated to all practices, this would generate £26.8 million in annual savings for the NHS, approximately 20% of the total possible savings from this method. The other two measures were not different after CCGs or practices were viewed. Practices that were viewed had worse prescribing quality scores overall prior to viewing. CONCLUSIONS We found a positive impact from the use of OpenPrescribing, specifically for the class of savings opportunities that can only be identified by using this tool. Furthermore, we show that it is possible to conduct a robust analysis of the impact of such a Web-based service on clinical practice.

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The impact of continuing medical education (CME) programs in metastatic castration-resistant prostate cancer (CRPC).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18280 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18280-e18280

Author(s):

Hamsa Jaganathan ◽

Anne Roc ◽

Andrew J. Armstrong ◽

Daniel J. George ◽

Wendy Turell

Keyword(s):

Clinical Practice ◽

Positive Impact ◽

Practice Change ◽

Castration Resistant Prostate Cancer ◽

Sequential Approach ◽

Short Period ◽

Concurrent Development ◽

Practice Knowledge ◽

Investigational Agents ◽

The Impact

e18280 Background: The concurrent development of many CRPC treatments within a short period of time has made prospective data on their sequential use and efficacy complicated, which have challenged clinician confidence, knowledge, and competency. Four hours of CME focused on the therapeutic management of CRPC were developed and participant responses analyzed to determine if these challenges were addressed. Methods: PlatformQ Health developed and executed 4 hours of virtual CME programs in CRPC. The 1st 2-hours, broadcast in May 2015 and offered online for 6 months, attracted a total of 545 learners. The 2nd 2-hours, broadcast in July 2016 and offered for 12 months, attracted a total of 345* learners. Survey-based evaluations targeted self-reported clinician data on satisfaction, clinical practice change and observed patient outcome. Clinician participation data and self-reported patients with CRPC seen per week were used in extrapolations of patients impacted by the CME education per week. Results: Between the 2015 and 2016 CME programs, learners gained confidence in their ability to employ a personalized, sequential approach to treat CRPC (12% vs 35%). Overall, 68% of all learners reported a positive clinical practice impact and 59% reported a positive impact on patient experience and/or outcomes as a result of CME participation. Learner commitment to change was consistently observed in both 2015 and 2016 programs in: medical and practice knowledge (90% and 94%, respectively), care attitudes (83% and 85%), practice behavior (79% and 77%), and their patients’ clinical outcomes (76% and 78%). An estimated 4,066 patients in 2015 and 3,374 patients in 2016 were impacted as a result of the education. Conclusions: Outcomes results of 2 years of education on evolving treatment paradigms of metastatic CRPC demonstrate learner improvements in both clinical practice and patient outcomes. Continuing education in the management of CRPC is recommended, particularly on strategies to appropriately sequence treatments, treatment of bone metastases, keeping abreast of new data, and understanding the rationale for investigational agents. *As of Jan 2017, data collection is ongoing

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Prospects of Big Data Analytics in Africa Healthcare System

Global Journal of Health Science ◽

10.5539/gjhs.v10n6p114 ◽

2018 ◽

Vol 10 (6) ◽

pp. 114

Author(s):

Akindele Akinnagbe ◽

K.Dharini Amitha Peiris ◽

Oluyemi Akinloye

Keyword(s):

Big Data ◽

Positive Impact ◽

Research Question ◽

Health Sector ◽

Big Data Analytics ◽

Healthcare Systems ◽

Ethical Challenges ◽

Big Data Applications ◽

The World ◽

The Impact

Big data is having a positive impact in almost every sphere of life, such as in military intelligence, space science, aviation, banking, and health. Big data is a growing force in healthcare. Even though healthcare systems in the developed world are recording some breakthroughs due to the application of big data, it is important to research the impact of big data in developing regions of the world, such as Africa. Healthcare systems in Africa are, in relative terms, behind the rest of the world. Platforms and technologies used to amass big data such as the Internet and mobile phones are already in use in Africa, thereby making big data applications to be emerging. Hence, the key research question we address is whether big data applications can improve healthcare in Africa especially during epidemics and through the public health system. In this study, a literature review is carried out, firstly to present cases of big data applications in healthcare in Africa, and secondly, to explore potential ethical challenges of such applications. This review will provide an update on the application of big data in the health sector in Africa that can be useful for future researchers and health care practitioners in Africa.

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