An article published in the “European Journal of Oncology Nursing” (June 2021, no. 45), a journal belonging to the Nature group, deals with the delicate issue of decision-making in pediatric care for children with cancer and the effect of ethical discussions among healthcare professionals.

The study aims to describe “perceptions of the decision-making process in relation to participation/non-participation in ethics discussions among healthcare professionals in pediatric oncology”.

Methods

To carry out this work, healthcare professionals working at three pediatric units where discussions on ethics were held, were asked to respond to a questionnaire aimed at describing the perceptions of involvement, influence, responsibility and understanding of ethics in decision-making.

Background

To understand the challenge that these professionals must take on, we briefly describe the context in which these ethical discussions take place prior to decision-making.

Children with life-threatening cancer demand particular attention with the most advanced medical procedures, support, and special care. The article quotes an experienced cancer pediatrician who states that these patients create great anxiety in the medical staff, since any decision can mean life or death for them.

The article mentions previous studies (see HERE), highlighting the main role of medical professionals and the extreme dedication of nurses in the treatment and care of these children, concluding in the need for a special dedication, responsibility and understanding of the professional team which, according to the authors, is only achievable through good ethical support.

Ethical climate

The article continues to analyze previous studies that assess the need for the work of the professional team to be carried out in an environment where the ethical aspects of the different decision-making, procedures and care of these patients prevail, concluding that teamwork, sharing the necessary information is key for professionals. To achieve this climate, the bioethical discussion on the case plays a decisive role.

Ethical support

The article then explains how to achieve efficient ethical team support. Ethical discussions occur spontaneously during daily work or in professional team meetings, the so-called Ethical Case Reflections (ECR). In this study, both forms of discussion have been analyzed showing their usefulness. The objective, not always achieved, is to involve the entire team of healthcare professionals (HCPs) in these discussions and obtain a consensus on the steps to follow.

Then, the authors present the results of research on the perceptions of the roles of healthcare professionals in the process of medical decisions made, which until now are scarce.

Finally, the excellent results obtained in pediatric oncology are shown when the ethical support of the team of healthcare professionals is well implemented.

We recommend the reader consult the original text because it is an updated review of what has been studied in this area of medicine and bioethics, (read HERE).

The article highlights the main results of this review that we transcribe below:

Existing research results.

  • Discussions about ethics can increase mutual understanding, consolidate attention, and facilitate decision-making.

New knowledge added

  • Participation in the ethics discussion was related to the perception of greater involvement in decisions and responsibility

 

  • The perception of registered doctors and nurses regarding participation in decisions and responsibility decreased when they were not present

 

  • Healthcare professionals had a high degree of understanding of the decision made during a discussion on ethics.

Conclusions

The final conclusion of the study is that ethical discussions in pediatric clinical practice enable higher levels of involvement from the inter-professional team in ethics of decision-making. The high degree of understanding of healthcare professionals about the decision made during an ethics discussion is noteworthy, which indicates the importance of ethics discussions and a great trust in their team members.

Our statement

The authors also comment that it would be necessary to carry out an analogous study of the families and those responsible for the minor patient.

From the point of view of personalistic bioethics, this study has great value for practical ethics and any advance in this regard, in addition to improving the performance of the work of the medical team, could create greater trust in parents and better quality of life of those involved.

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