The Ethics of Opt-Out Provider-Initiated HIV Testing in the Emergency Department

急诊科选择退出医疗服务提供者发起的艾滋病毒检测的道德规范

• 批准号: 7623271
• 负责人: Ethan Adrian Cowan
• 金额: $ 13.51万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-01-20 至 2013-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7623271
• 关键词: Accident and Emergency department; Adoption; Adult; Attitude; Belief; Bioethics; Centers for Disease Control and Prevention (U.S.); Clinic; Clinical; Clinical Research; Clinical Trials; Counseling; Data; Development; Educational Curriculum; Elements; Emergency Medicine; Empirical Research; Environment; Epidemic; Ethicists; Ethics; Exercise; Faculty; Goals; Guidelines; HIV; Happiness; Head; Healthcare; Human immunodeficiency virus test; Individual; Informed Consent; International; K-Series Research Career Programs; Knowledge; Language; Lead; Medical; Medical center; Medicine; Mentors; Methods; Monitor; Patient Care; Patients; Population; Prevention Guidelines; Primary Health Care; Procedures; Process; Provider; Public Health; Public Health Practice; Recommendation; Research; Research Methodology; Research Personnel; Rights; Science; Site; Testing; Training; Uninsured; United States; United States National Institutes of Health; Universities; base; clinical care; college; experience; instrument; professor; programs; safety net; scale up; treatment center

DESCRIPTION (provided by applicant): Dr. Ethan Cowan is an Assistant Professor in the Department of Emergency Medicine at the Albert Einstein College of Medicine. With a background in research on informed consent for clinical procedures, Dr. Cowan is now seeking to develop expertise in empirical research in bioethics. Dr. Cowan is planning to study the intersection of bioethics as it applies to the individual and the health of the public. Emergency Departments (EDs) are a unique environment for this type of research because they provide individual clinical care and serve as a "safety net" for the population by treating the uninsured and underserved making it difficult to separate clinical and public health practice. The proposed study examines the ethical implications of a new public health initiative, opt-out provider-initiated HIV testing (hereby referred to as opt-out testing) in the ED. A mixture of qualitative and quantitative methods will be used to explore ED patients' and providers' beliefs, attitudes and acceptability toward opt-out testing. Ethical aspects of opt-out HIV testing will be examined including, 1) the ability of patients to understand that they have the right to decline the HIV test and that testing will be performed unless they exercise that right, 2) patients' understanding of HIV pretest information prior to undergoing testing, and 3) the impact of language on the understanding of opt-out testing and HIV pretest information. The research will be conducted in the urban ED of the Jacobi Medical Center, serving over 70,000 adult patients annually and staffed by faculty experienced in conducting NIH clinical trials. Dr. Cowan's training plan includes formal coursework, direct mentoring, specialized seminars, and practical experience in project planning and execution. Courses have been selected from the sociomedical sciences curriculum of Columbia University and the ethics program at Union Graduate College. Headed by a world renowned ethicist, Dr. Ruth Macklin, a committee of experts in clinical research methods will serve as mentors for this project. The proposed research has direct impact on public health. The instruments developed in this study may be adapted for use in evaluating and monitoring the ethical aspects of national and international opt-out testing programs. Furthermore, if this study demonstrates that opt-out testing is acceptable and can be ethically implemented this will lend support for adoption of ED based opt-out testing programs on a national scale.

描述（由申请人提供）：Ethan Cowan 博士是阿尔伯特·爱因斯坦医学院急诊医学系的助理教授。 Cowan 博士拥有临床程序知情同意研究背景，目前正在寻求发展生物伦理学实证研究方面的专业知识。考恩博士计划研究生物伦理学的交叉点，因为它适用于个人和公众的健康。急诊科 (ED) 是此类研究的独特环境，因为它们提供个人临床护理，并通过治疗未投保和服务不足的人来充当人群的“安全网”，从而使临床和公共卫生实践难以分开。拟议的研究探讨了一项新的公共卫生举措的伦理影响，即在急诊室选择退出提供者发起的艾滋病毒检测（以下称为选择退出检测）。将采用定性和定量相结合的方法来探索 ED 患者和提供者对选择退出测试的信念、态度和可接受性。选择退出艾滋病毒检测的道德方面将受到审查，包括：1）患者了解他们有权拒绝艾滋病毒检测以及除非他们行使该权利否则将进行检测的能力，2）患者在接受检测之前对艾滋病毒预检测信息的理解，以及3）语言对理解选择退出检测和艾滋病毒预检测信息的影响。该研究将在雅可比医疗中心的城市急诊室进行，该中心每年为 70,000 多名成年患者提供服务，并由具有 NIH 临床试验经验的教职人员组成。 Cowan 博士的培训计划包括正式课程、直接指导、专业研讨会以及项目规划和执行方面的实践经验。课程选自哥伦比亚大学的社会医学科学课程和联合研究生院的伦理学课程。由世界著名伦理学家 Ruth Macklin 博士领导的临床研究方法专家委员会将担任该项目的导师。拟议的研究对公众健康有直接影响。本研究中开发的工具可用于评估和监测国家和国际选择退出测试计划的道德方面。此外，如果这项研究表明选择退出测试是可以接受的并且可以在道德上实施，这将为在全国范围内采用基于 ED 的选择退出测试计划提供支持。