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A multidimensional model of ethical challenges in hemodialysis: a qualitative study for specialist physicians

Yuxiu Jia1,2, Bin Dong3, Yuehui Shi1

  • 1College of First Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.

BMC Medical Ethics
|October 22, 2025
PubMed

Insights

Physicians in Traditional Chinese Medicine (TCM) hospitals face ethical challenges in hemodialysis care due to systemic pressures and interprofessional dynamics. A new model identifies multi-level interventions for policy, collaboration, and practitioner support.

Area of Science:

  • Medical Ethics
  • Healthcare Management
  • Traditional Chinese Medicine

Background:

  • Chronic Kidney Disease (CKD) affects 13% of China's population, with hemodialysis (HD) consuming significant healthcare expenditure.
  • HD physicians in Traditional Chinese Medicine (TCM) hospitals encounter unique ethical dilemmas due to dual practice paradigms, cultural expectations, and systemic pressures.
  • Social-Ecological Systems Theory provides a framework to analyze these complex challenges.

Purpose of the Study:

  • To analyze the multilayered ethical challenges faced by hemodialysis physicians in TCM hospitals.
  • To develop a structured, multidimensional ethical model based on the Social-Ecological Systems Theory.

Main Methods:

  • Qualitative phenomenological research design.
  • Maximum variation purposive sampling of 28 hemodialysis physicians from six TCM hospitals in Shandong Province, China.
  • Data collected via focus group and in-depth individual interviews (November 2024 - January 2025), analyzed using Colaizzi's descriptive analysis framework.

Main Results:

  • Ethical challenges were categorized into three themes: macro-system (policy, organizational, cultural), meso-system (interprofessional dynamics: doctor-doctor, doctor-nurse, doctor-patient relationships), and micro-system (individual difficulties).
  • A three-tiered conceptual model illustrating these multilevel challenges was developed.

Conclusions:

  • Ethical challenges in hemodialysis practice are multi-level, encompassing systemic policies, interprofessional relationships, and individual dilemmas.
  • Targeted interventions are needed: policy reforms, team-based strategies for clinical collaboration, and support systems for practitioners.
  • Evidence-based insights can guide stakeholders in developing comprehensive solutions for interconnected ethical challenges.
Abstract

Keywords:
Ethical issueHemodialysisPhysiciansQualitative studySocial ecological system theory

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