Positioning Ethics When Direct Patient Care is Prioritized: Experiences from Implementing Ethics Case Reflection...

Area of Science:

• Medical Ethics
• Pediatric Oncology
• Qualitative Research

Background:

• Caring for children with cancer presents significant ethical challenges.
• Ethics Case Reflection (ECR) rounds offer a structured approach for healthcare teams to discuss and resolve ethical dilemmas in patient care.
• A Nordic working group developed a training course for ECR facilitators in pediatric oncology.

Purpose of the Study:

• To explore the experiences of healthcare professionals (HCPs) who participated in a training course and subsequently implemented Ethics Case Reflection (ECR) rounds in their clinical practice.
• To understand the challenges and facilitators of integrating ECR rounds into the daily workflow of childhood cancer care settings.

Main Methods:

• Qualitative study employing classic grounded theory.
• Data collection through 3 focus group interviews (n=22) and 27 individual interviews (n=17) with HCP trainees.
• Concurrent data analysis alongside data collection.

Main Results:

• 'Positioning ethics' emerged as the core category, reflecting the challenge of prioritizing ethics in a context focused on direct patient care.
• Time for ethics reflection was often perceived as a luxury, not a clinical priority.
• Successful strategies for "positioning ethics" included allying, promoting, scheduling, and identifying ethical dilemmas, with varying effectiveness.

Conclusions:

• The study highlights the need to question the polarization between direct patient care and ethical reflection.
• Integrating ethics reflection into standard care is essential for enhancing ethical competence in pediatric oncology.
• Further research is needed on promoting ethical competence in both practice and education for HCPs.