Which ethical values underpin England's National Health Service reset of paediatric and maternity services following COVID-19: a rapid review.
Which ethical values underpin England's National Health Service reset of paediatric and maternity services following COVID-19: a rapid review.
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DOI：
10.1136/bmjopen-2021-049214
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发表时间：
2021-06-08
期刊：
影响因子：
2.9
通讯作者：
Frith L
中科院分区：
文献类型：
--
作者：
Chiumento A;Baines P;Redhead C;Fovargue S;Draper H;Frith L
确定在国民医疗服务体系中重新设置非新冠肺炎的儿科外科和妇产科服务的伦理价值，以指导决策。快速回顾2020年4月29日至12月31日的学术和灰色文献来源，涵盖非紧急、非新冠肺炎医疗保健。根据英国政府大流行流感伦理框架的改编版本，对资料进行了主题综合，以确定支撑伦理原则的基础。还评估了规范性参与的力度和资料来源的质量。英国国民健康保险制度的产科和儿科外科服务。搜索于2020年9月8日至10月12日进行，并于2021年3月更新，确定了48个符合纳入标准的来源。产生的主题包括：工作人员安全；协作工作--包括整个医疗系统的相互依赖；互惠；以及服务恢复方面的包容性，例如通过解决服务获得方面的不平等问题。在工作人员和患者安全的主题中嵌入了新的工作方式，例如迅速推出远程医疗。在评估方面，许多资料来源没有明确考虑道德原则如何相互适用或相互平衡。政策来源的弱点包括缺乏公众和用户的参与，以及缺乏监测和评价标准。我们的发现表明，关系是一个重要的伦理原则，指导重新设置国民健康保险制度、非新冠肺炎的儿科手术和产科服务。消息人士明确强调了寻求最大限度地减少对关怀和依赖关系的破坏，同时关注公共安全的伦理重要性。与伦理原则的接触是伦理的轻描淡写，消息来源提到原则时只是顺带而过，而不是明确地应用它们。这使得决策者和医疗保健专业人员没有一个可操作的道德框架来适用于困难的重置决策，并面临决策过程中出现不一致的风险。我们建议进行进一步的研究，以确认或改进通过我们的分析制定的重置阶段伦理框架的有用性。
To identify ethical values guiding decision making in resetting non-COVID-19 paediatric surgery and maternity services in the National Health Service (NHS). A rapid review of academic and grey literature sources from 29 April to 31 December 2020, covering non-urgent, non-COVID-19 healthcare. Sources were thematically synthesised against an adapted version of the UK Government’s Pandemic Flu Ethical Framework to identify underpinning ethical principles. The strength of normative engagement and the quality of the sources were also assessed. NHS maternity and paediatric surgery services in England. Searches conducted 8 September–12 October 2020, and updated in March 2021, identified 48 sources meeting the inclusion criteria. Themes that arose include: staff safety; collaborative working – including mutual dependencies across the healthcare system; reciprocity; and inclusivity in service recovery, for example, by addressing inequalities in service access. Embedded in the theme of staff and patient safety is embracing new ways of working, such as the rapid roll out of telemedicine. On assessment, many sources did not explicitly consider how ethical principles might be applied or balanced against one another. Weaknesses in the policy sources included a lack of public and user involvement and the absence of monitoring and evaluation criteria. Our findings suggest that relationality is a prominent ethical principle informing resetting NHS non-COVID-19 paediatric surgery and maternity services. Sources explicitly highlight the ethical importance of seeking to minimise disruption to caring and dependent relationships, while simultaneously attending to public safety. Engagement with ethical principles was ethics-lite, with sources mentioning principles in passing rather than explicitly applying them. This leaves decision makers and healthcare professionals without an operationalisable ethical framework to apply to difficult reset decisions and risks inconsistencies in decision making. We recommend further research to confirm or refine the usefulness of the reset phase ethical framework developed through our analysis.
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影响因子：
2.4
作者：
Chervenak, Frank A.;McCullough, Laurence B.;Kurjak, Asim
通讯作者：
Kurjak, Asim
影响因子：
--
作者：
Dove ES;Kelly SE;Lucivero F;Machirori M;Dheensa S;Prainsack B
通讯作者：
Prainsack B
影响因子：
37.8
作者：
Edelson, Dana P.;Sasson, Comilla;Topjian, Alexis A.
通讯作者：
Topjian, Alexis A.
影响因子：
14.6
作者：
Brouwers, Melissa C.;Kho, Michelle E.;Zitzelsberger, Louise
通讯作者：
Zitzelsberger, Louise
DOI：
10.1016/s0140-6736(20)32000-6
发表时间：
2020-09-26
期刊：
Lancet (London, England)
影响因子：
--
作者：
Horton R
通讯作者：
Horton R