Health Care Analysis最新文献_第8页

Altruistic Vaccination: Insights from Two Focus Group Studies. 利他主义疫苗接种：两项焦点小组研究的启示。

IF 1.8 3区哲学

Health Care Analysis Pub Date : 2022-12-01 DOI: 10.1007/s10728-022-00453-5

Steven R Kraaijeveld, Bob C Mulder

{"title":"Altruistic Vaccination: Insights from Two Focus Group Studies.","authors":"Steven R Kraaijeveld, Bob C Mulder","doi":"10.1007/s10728-022-00453-5","DOIUrl":"10.1007/s10728-022-00453-5","url":null,"abstract":"Vaccination can protect vaccinated individuals and often also prevent them from spreading disease to other people. This opens up the possibility of getting vaccinated for the sake of others. In fact, altruistic vaccination has recently been conceptualized as a kind of vaccination that is undertaken primary for the benefit of others. In order to better understand the potential role of altruistic motives in people's vaccination decisions, we conducted two focus group studies with a total of 37 participants. Study 1 included three focus groups on the subject of HPV vaccination for boys. Study 2 included three focus groups on the subject of pertussis and measles vaccination for childcare workers. We found substantial evidence of other-regarding motives across all focus groups, which suggests that altruistic motives could be an important factor when it comes to people's vaccination decisions. We address the significance of these findings for vaccination policy surrounding HPV vaccination for boys and vaccination for childcare workers. We also extend the findings to normative work on vaccination for the sake of others more generally.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":"30 3-4","pages":"275-295"},"PeriodicalIF":1.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9713734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10720450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Invisible Patient: Concerns about Donor Exploitation in Stem Cell Research. 看不见的病人:对干细胞研究中供体开发的关注。

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2022-12-01 DOI: 10.1007/s10728-022-00448-2

Pär Segerdahl

引用次数: 0

Doctors as Resource Stewards? Translating High-Value, Cost-Conscious Care to the Consulting Room. 医生是资源管理者?将高价值、有成本意识的护理转化为咨询室。

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2022-12-01 DOI: 10.1007/s10728-022-00446-4

Marjolein Moleman, Teun Zuiderent-Jerak, Marianne Lageweg, Gianni L van den Braak, Tjerk Jan Schuitmaker-Warnaar

{"title":"Doctors as Resource Stewards? Translating High-Value, Cost-Conscious Care to the Consulting Room.","authors":"Marjolein Moleman, Teun Zuiderent-Jerak, Marianne Lageweg, Gianni L van den Braak, Tjerk Jan Schuitmaker-Warnaar","doi":"10.1007/s10728-022-00446-4","DOIUrl":"https://doi.org/10.1007/s10728-022-00446-4","url":null,"abstract":"After many policy attempts to tackle the persistent rise in the costs of health care, physicians are increasingly seen as potentially effective resource stewards. Frameworks including the quadruple aim, value-based health care and choosing wisely underline the importance of positive engagement of the health care workforce in reinventing the system-paving the way to real affordability by defining the right care. Current programmes focus on educating future doctors to provide 'high-value, cost-conscious care' (HVCCC), which proponents believe is the future of sustainable medical practice. Such programmes, which aim to extend population-level allocation concerns to interactions between an individual doctor and patient, have generated lively debates about the ethics of expanding doctors' professional accountability. To empirically ground this discussion, we conducted a qualitative interview study to examine what happens when resource stewardship responsibilities are extended to the consulting room. Attempts to deliver HVCCC were found to involve inevitable trade-offs between benefits to the individual patient and (social) costs, medical uncertainty and efficiency, and between resource stewardship and trust. Physicians reconcile this by justifying good-value care in terms of what is in the best interest of individual patients-redefining the currency of value from monetary costs to a patient's quality of life, and cost-conscious care as reflective medical practice. Micro-level resource stewardship thus becomes a matter of working reflexively and reducing wasteful forms of care, rather than of making difficult choices about resource allocation.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":"30 3-4","pages":"215-239"},"PeriodicalIF":1.9,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9741564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10408769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 5

Epistemic Injustice in Incident Investigations: A Qualitative Study. 事件调查中的认知不公:一项质的研究。

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2022-12-01 DOI: 10.1007/s10728-022-00447-3

Josje Kok, David de Kam, Ian Leistikow, Kor Grit, Roland Bal

{"title":"Epistemic Injustice in Incident Investigations: A Qualitative Study.","authors":"Josje Kok, David de Kam, Ian Leistikow, Kor Grit, Roland Bal","doi":"10.1007/s10728-022-00447-3","DOIUrl":"https://doi.org/10.1007/s10728-022-00447-3","url":null,"abstract":"Serious incident investigations-often conducted by means of Root Cause Analysis methodologies-are increasingly seen as platforms to learn from multiple perspectives and experiences: professionals, patients and their families alike. Underlying this principle of inclusiveness is the idea that healthcare staff and service users hold unique and valuable knowledge that can inform learning, as well as the notion that learning is a social process that involves people actively reflecting on shared knowledge. Despite initiatives to facilitate inclusiveness, research shows that embracing and learning from diverse perspectives is difficult. Using the concept of 'epistemic injustice', pointing at practices of someone's knowledge being unjustly disqualified or devalued, we analyze the way incident investigations are organized and executed with the aim to understand why it is difficult to embrace and learn from the multiple perspectives voiced in incident investigations. We draw from 73 semi-structured interviews with healthcare leaders, managers, healthcare professionals, incident investigators and inspectors, document analyses and ethnographic observations. Our analysis identified several structures in the incident investigation process, that can promote or hinder an actor's epistemic contribution in the process of incident investigations. Rather than repeat calls to 'involve more' and 'listen better', we encourage policy makers to be mindful of and address the structures that can cause epistemic injustice. This can improve the outcome of incident investigations and can help to do justice to the lived experiences of the involved actors in the aftermath of a serious incident.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":"30 3-4","pages":"254-274"},"PeriodicalIF":1.9,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9741561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10347702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Taming Wickedness: Towards an Implementation Framework for Medical Ethics. 驯服邪恶:医学伦理学的实施框架。

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2022-12-01 DOI: 10.1007/s10728-022-00445-5

Erin Taylor

引用次数: 1

Should Digital Contact Tracing Technologies be used to Control COVID-19? Perspectives from an Australian Public Deliberation. 是否应使用数字接触追踪技术控制 COVID-19？来自澳大利亚公众讨论的观点。

IF 1.8 3区哲学

Health Care Analysis Pub Date : 2022-06-01 Epub Date: 2021-10-26 DOI: 10.1007/s10728-021-00441-1

Chris Degeling, Julie Hall, Jane Johnson, Roba Abbas, Shopna Bag, Gwendolyn L Gilbert

{"title":"Should Digital Contact Tracing Technologies be used to Control COVID-19? Perspectives from an Australian Public Deliberation.","authors":"Chris Degeling, Julie Hall, Jane Johnson, Roba Abbas, Shopna Bag, Gwendolyn L Gilbert","doi":"10.1007/s10728-021-00441-1","DOIUrl":"10.1007/s10728-021-00441-1","url":null,"abstract":"Mobile phone-based applications (apps) can promote faster targeted actions to control COVID-19. However, digital contact tracing systems raise concerns about data security, system effectiveness, and their potential to normalise privacy-invasive surveillance technologies. In the absence of mandates, public uptake depends on the acceptability and perceived legitimacy of using technologies that log interactions between individuals to build public health capacity. We report on six online deliberative workshops convened in New South Wales to consider the appropriateness of using the COVIDSafe app to enhance Australian contact tracing systems. All groups took the position (by majority) that the protections enacted in the app design and supporting legislation were appropriate. This support is contingent on several system attributes including: the voluntariness of the COVIDSafe app; that the system relies on proximity rather than location tracking; and, that data access is restricted to local public health practitioners undertaking contact tracing. Despite sustained scepticism in media coverage, there was an underlying willingness to trust Australian governing institutions such that in principle acceptance of the new contact tracing technology was easy to obtain. However, tensions between the need to prove system effectiveness through operational transparency and requirements for privacy protections could be limiting public uptake. Our study shows that informed citizens are willing to trade their privacy for common goods such as COVID-19 suppression. But low case numbers and cautionary public discourses can make trustworthiness difficult to establish because some will only do so when it can be demonstrated that the benefits justify the costs to individuals.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":"30 2","pages":"97-114"},"PeriodicalIF":1.8,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8545621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39559047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ethical Guidance for Hard Decisions: A Critical Review of Early International COVID-19 ICU Triage Guidelines. 艰难决策的伦理指导:对早期国际COVID-19 ICU分诊指南的批判性回顾。

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2022-06-01 Epub Date: 2021-10-26 DOI: 10.1007/s10728-021-00442-0

Yves Saint James Aquino, Wendy A Rogers, Jackie Leach Scully, Farah Magrabi, Stacy M Carter

{"title":"Ethical Guidance for Hard Decisions: A Critical Review of Early International COVID-19 ICU Triage Guidelines.","authors":"Yves Saint James Aquino, Wendy A Rogers, Jackie Leach Scully, Farah Magrabi, Stacy M Carter","doi":"10.1007/s10728-021-00442-0","DOIUrl":"https://doi.org/10.1007/s10728-021-00442-0","url":null,"abstract":"This article provides a critical comparative analysis of the substantive and procedural values and ethical concepts articulated in guidelines for allocating scarce resources in the COVID-19 pandemic. We identified 21 local and national guidelines written in English, Spanish, German and French; applicable to specific and identifiable jurisdictions; and providing guidance to clinicians for decision making when allocating critical care resources during the COVID-19 pandemic. US guidelines were not included, as these had recently been reviewed elsewhere. Information was extracted from each guideline on: 1) the development process; 2) the presence and nature of ethical, medical and social criteria for allocating critical care resources; and 3) the membership of and decision-making procedure of any triage committees. Results of our analysis show the majority appealed primarily to consequentialist reasoning in making allocation decisions, tempered by a largely pluralistic approach to other substantive and procedural values and ethical concepts. Medical and social criteria included medical need, co-morbidities, prognosis, age, disability and other factors, with a focus on seemingly objective medical criteria. There was little or no guidance on how to reconcile competing criteria, and little attention to internal contradictions within individual guidelines. Our analysis reveals the challenges in developing sound ethical guidance for allocating scarce medical resources, highlighting problems in operationalising ethical concepts and principles, divergence between guidelines, unresolved contradictions within the same guideline, and use of naïve objectivism in employing widely used medical criteria for allocating ICU resources.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":"30 2","pages":"163-195"},"PeriodicalIF":1.9,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39561781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 9

Justice, Transparency and the Guiding Principles of the UK's National Institute for Health and Care Excellence. 公正、透明和英国国家健康与护理卓越研究所的指导原则。

IF 1.8 3区哲学

Health Care Analysis Pub Date : 2022-06-01 Epub Date: 2021-11-08 DOI: 10.1007/s10728-021-00444-y

Victoria Charlton

{"title":"Justice, Transparency and the Guiding Principles of the UK's National Institute for Health and Care Excellence.","authors":"Victoria Charlton","doi":"10.1007/s10728-021-00444-y","DOIUrl":"10.1007/s10728-021-00444-y","url":null,"abstract":"The National Institute for Health and Care Excellence (NICE) is the UK's primary healthcare priority-setting body, responsible for advising the National Health Service in England on which technologies to fund and which to reject. Until recently, the normative approach underlying this advice was described in a 2008 document entitled 'Social value judgements: Principles for the development of NICE guidance' (SVJ). In January 2020, however, NICE replaced SVJ with a new articulation of its guiding principles. Given the significant evolution of NICE's methods between 2008 and 2020, this study examines whether this new document ('Principles') offers a transparent account of NICE's current normative approach. It finds that it does not, deriving much of its content directly from SVJ and failing to fully acknowledge or explain how and why NICE's approach has since changed. In particular, Principles is found to offer a largely procedural account of NICE decision-making, despite evidence of the increasing reliance of NICE's methods on substantive decision-rules and 'modifiers' that cannot be justified in purely procedural terms. Thus, while Principles tells NICE's stakeholders much about how the organisation goes about the process of decision-making, it tells them little about the substantive grounds on which its decisions are now based. It is therefore argued that Principles does not offer a transparent account of NICE's normative approach (either alone, or alongside other documents) and that, given NICE's reliance on transparency as a requirement of procedural justice, NICE does not in this respect satisfy its own specification of a just decision-maker.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":"30 2","pages":"115-145"},"PeriodicalIF":1.8,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39602004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pandemic Risk and Standpoint Epistemology: A Matter of Solidarity. 流行病风险与立场认识论：团结问题。

IF 1.8 3区哲学

Health Care Analysis Pub Date : 2022-06-01 Epub Date: 2021-10-25 DOI: 10.1007/s10728-021-00443-z

Katrien Schaubroeck, Kristien Hens

引用次数: 0

Practitioner Bias as an Explanation for Low Rates of Palliative Care Among Patients with Advanced Dementia. 医生偏见是晚期痴呆患者低姑息治疗率的一个解释。

IF 1.9 3区哲学

Health Care Analysis Pub Date : 2022-03-01 Epub Date: 2021-03-30 DOI: 10.1007/s10728-021-00429-x

Meira Erel, Esther-Lee Marcus, Freda Dekeyser-Ganz

{"title":"Practitioner Bias as an Explanation for Low Rates of Palliative Care Among Patients with Advanced Dementia.","authors":"Meira Erel, Esther-Lee Marcus, Freda Dekeyser-Ganz","doi":"10.1007/s10728-021-00429-x","DOIUrl":"https://doi.org/10.1007/s10728-021-00429-x","url":null,"abstract":"Patients with advanced dementia are less likely than those with other terminal illnesses to receive palliative care. Due to the nature and course of dementia, there may be a failure to recognize the terminal stage of the disease. A possible and under-investigated explanation for this healthcare disparity is the healthcare practitioner who plays a primary role in end-of-life decision-making. Two potential areas that might impact provider decision-making are cognitive biases and moral considerations. In this analysis, we demonstrate how the cognitive biases and moral considerations of practitioners related to clinical decision-making are inherent in clinical practice and may impact on providers' accuracy related to diagnostic and treatment related decision-making associated with patients with advanced dementia. Anchoring, default, availability, representativeness and framing biases are cognitive biases based on the \"Two System Model\" that relate to decision-making in end-of-life care. In patients with advanced dementia, those biases may result in a tendency to adhere to traditional mandatory care, involving an aggressive approach to care, which values saving lives at all costs, without taking into account the possible suffering and long-term consequences. Aspects such as moral sensitivity and moral courage play an important role in ethical decision-making related to advanced dementia. Investigations of clinical decision-making that include the cognitive biases and ethical considerations of practitioners might advance the comprehensive understanding of the clinical decision-making process related to care of patients with advanced dementia and promote the quality of care given to this population.","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":"30 1","pages":"57-72"},"PeriodicalIF":1.9,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10728-021-00429-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25530550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 6