Legal Involvement in Pediatric Cancer Treatment Refusal: A Qualitative Study.

IF 6.2 2区 医学 Q1 PEDIATRICS
Amy E Caruso Brown,Laura M Beskow,Daniel J Benedetti
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Abstract

OBJECTIVES To characterize the spectrum of legal options considered in cases of treatment refusal, nonadherence, and abandonment (TRNA); clinicians' thought processes regarding legal intervention; and perceived consequences of legal involvement. METHODS We conducted in-depth, semistructured interviews with 30 pediatric oncologists between May and September of 2019 regarding experiences with TRNA. The interview guide covered types of conflicts encountered; factors and strategies considered in response; effects of TRNA cases, personally and professionally; the role of ethical frameworks and legal requirements; and resources needed to manage TRNA cases. Interviews were transcribed and coded iteratively using thematic analysis. RESULTS Participants represented a range of institutional sizes, geographic locations, and years in practice. Twenty-five of 30 interviewees discussed legal consideration with regard to TRNA. Most participants first engaged the legal system through child protective service agencies. They considered patient age, treatment efficacy, quality of life (burden of treatment), and prognosis; family resources and social context; and preservation of therapeutic relationships and possible consequences of reporting. Experiences and outcomes of legal involvement varied. CONCLUSIONS Clinicians struggle with the tension between obligations to report medical neglect and fears that reporting may result in more harm than benefit to the child in question. We urgently need more dialog between health care professionals and child protective services and legal professionals. Stakeholders from both groups would benefit from a greater understanding of the other's thought processes; clarity regarding the relevant facts; and mutual progress toward creative, evidence-based solutions to working out these complex challenges.
儿科癌症治疗拒绝中的法律介入:定性研究。
目标描述在治疗拒绝、不依从和放弃(TRNA)情况下考虑的法律选择范围;临床医生关于法律干预的思维过程;以及法律介入的感知后果。方法我们在 2019 年 5 月至 9 月期间对 30 名儿科肿瘤学家进行了深入的半结构式访谈,了解他们在 TRNA 方面的经验。访谈指南涵盖了所遇到的冲突类型;应对时考虑的因素和策略;TRNA 病例对个人和职业的影响;伦理框架和法律要求的作用;以及管理 TRNA 病例所需的资源。对访谈内容进行了誊写,并采用主题分析法对访谈内容进行了反复编码。结果参加访谈的人员代表了不同的机构规模、地理位置和从业年限。30 位受访者中有 25 位讨论了与 TRNA 有关的法律问题。大多数受访者首先通过儿童保护服务机构与法律系统接触。他们考虑的因素包括:患者年龄、治疗效果、生活质量(治疗负担)和预后;家庭资源和社会环境;治疗关系的维护和报告可能带来的后果。结论临床医生既要履行报告医疗疏忽的义务,又担心报告医疗疏忽会给患儿带来弊大于利的后果,他们在这两者之间挣扎。我们迫切需要医疗保健专业人员与儿童保护服务和法律专业人员之间进行更多的对话。两个群体的利益相关者都将从以下方面受益:更好地理解对方的思维过程;澄清相关事实;共同推进以证据为基础的创造性解决方案,以解决这些复杂的难题。
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来源期刊
Pediatrics
Pediatrics 医学-小儿科
CiteScore
12.80
自引率
5.00%
发文量
791
审稿时长
2-3 weeks
期刊介绍: The Pediatrics® journal is the official flagship journal of the American Academy of Pediatrics (AAP). It is widely cited in the field of pediatric medicine and is recognized as the leading journal in the field. The journal publishes original research and evidence-based articles, which provide authoritative information to help readers stay up-to-date with the latest developments in pediatric medicine. The content is peer-reviewed and undergoes rigorous evaluation to ensure its quality and reliability. Pediatrics also serves as a valuable resource for conducting new research studies and supporting education and training activities in the field of pediatrics. It aims to enhance the quality of pediatric outpatient and inpatient care by disseminating valuable knowledge and insights. As of 2023, Pediatrics has an impressive Journal Impact Factor (IF) Score of 8.0. The IF is a measure of a journal's influence and importance in the scientific community, with higher scores indicating a greater impact. This score reflects the significance and reach of the research published in Pediatrics, further establishing its prominence in the field of pediatric medicine.
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