Decision Making With Bioethical Perspective in Palliative Care en Mexico

Descriptive Study on Decision Making With a Bioethical Perspective in Some Cities of Mexico

All clinical practice includes decision making, and sometimes you are ethically challenging because of the consequences it will bring to the patient, the health professional or society in general. Ethics seeks the best solution to a better treatment and seeks to increase the quality of life of the patient with correct decision making. Ethical / bioethical considerations are of a generic nature, and do not apply to specific situations. Therefore, it is suggested that there should be guidelines or recommendations in the field of palliative care in Mexico that may be an adjunct to decision making. The relevance of knowledge, application and management of ethical / bioethical recommendations is unknown as part of decision-making by professionals dedicated to palliative care in our country, taking into consideration the principles of autonomy, beneficence, non-malfeasance and Justice. It is necessary to consider the participation of patients, caregivers and health personnel in this decision making process of decisions. This study intends to identify the current situation of this issue in Mexico.

To analyze the characteristics of decision-making with bioethical involvement in palliative care in a representative sample of care professionals in some regions of the country.

Quantitative method:

• Describe the current situation in decision-making with bioethical involvement in palliative care.
• Identify if the personnel dedicated to palliative care know guidelines or recommendations related to decision-making in palliative care and the current legal framework.
• Know the strategies that palliative care personnel follow in situations in which the decision to make is difficult or problematic.

Qualitative method:

• Know the particular situations that signify a conflict or situation with bioethical implications for health professionals in palliative care.
• Analyze the variables that influence decision-making around the application of bioethics in palliative care.

Study Overview

• Status: Completed
• Conditions: Palliative Care

Detailed Description

Mixed study, for the quantitative part, it was prospective, descriptive, and cross-sectional investigation; on the qualitative part it was a case study. A sample of 72 health professionals was considered for the quantitative part and 8 for the qualitative part. The sampling strategy was for convenience. Data collection was achieved through a semi-structured survey applied in a virtual environment with the Google Forms platform. The quantitative data analysis was with descriptive measures of central tendency using the Statistical Package for the Social Sciences 21® (SPSS) software, and the qualitative ones with thematic content analysis techinique through the Qualitative Data Analysis Atlas Ti version 6.0® software.

Informed consent was obtained from the participants for the use of the data.

• Study Type: Observational
• Enrollment (Actual): 72

Contacts and Locations

Study Locations

• Mexico
  • Jalisco
    • Zapopan, Jalisco, Mexico, 45170
      • Rosa Margarita Alvarez Alvarez

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Quantitative sampling:

Non-probabilistic sampling for convenience, of an open nature. Aimed at a specific professional profile according to the theme, the study identified the characteristics of decision-making of the health personnel working in the context of palliative care in different cities of Mexico, the result was not considered generalizable. The Statistical Package for the Social Sciences 21® (SPSS) software was used for statistical analysis.

Qualitative sampling:

A sampling called critical case was followed, according to which cases are chosen based on characteristics that can provide different perspectives on the phenomenon, this choice was based on the profession of the participant, the years of seniority in palliative care and that the cases reflected a bioethical conflict or dilemma. Qualitative Data Analysis Atlas Ti version 6.0® software was used for statistical analysis.

Description

Inclusion criteria for the quantitative sample:

• Agree to participate in the study.
• Health personnel engaged in palliative care
• Work in the public and/or private sector.

Non- inclusion criteria:

• Incomplete survey.

Elegibility criteria for the qualitative sample:

• The participants who answered questions 19 and 20 of the survey sent by Google Forms were chosen.
• Of these, the profession of origin was identified to select those that belonged to professions that are from the disciplines that make up the multidisciplinary teams in palliative care, additionally; The time of work experience in this area was considered, they were included with more than 10 years of experience and less than 10.
• Likewise, the variability of cases and those that reflected an ethical conflict were looked for.

Ineligibility criteria for the qualitative sample:

• Those cases where similar situations or scenarios were described were discarded.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quantitative results	Demographic data, Bioethics training, Experience with clinical situations with bioethical implication.	1 year
Qualitative results	The last two questions with a qualitative approach, the objective is to obtain a broader view of the characteristics of decision-making, considering that palliative care by definition is an approach to care from different disciplines	1 year

Collaborators and Investigators

• Sponsor: University of Guadalajara
• Investigators: Study Director: Rodrigo Ramos-Zuñiga, MD PhD, University of Guadalajara

Study record dates

Study Major Dates

• Study Start (Actual): April 12, 2019
• Primary Completion (Actual): August 20, 2019
• Study Completion (Actual): November 5, 2020

Study Registration Dates

• First Submitted: April 7, 2019
• First Submitted That Met QC Criteria: April 9, 2019
• First Posted (Actual): April 12, 2019

Study Record Updates

• Last Update Posted (Actual): December 11, 2020
• Last Update Submitted That Met QC Criteria: December 8, 2020
• Last Verified: December 1, 2020

More Information

Terms related to this study

• Keywords: Decision Making; Palliative Care; Guideline; Bioethics; Terminal Care
• Other Study ID Numbers: 218901374

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No