Moral Distress with Obstacles to Hepatitis C Treatment: A Council of Academic Family Medicine Educational Research Alliance (CERA) Study of Family Medicine Program Directors

被引:6
|
作者
Simha, Aditya [1 ]
Webb, Camille Maria [2 ]
Prasad, Ramakrishna [3 ]
Kolb, N. Randall [4 ]
Veldkamp, Peter J. [5 ]
机构
[1] Univ Wisconsin, Dept Management, Whitewater, WI 53190 USA
[2] Univ Pittsburgh, Med Ctr, Dept Med, Internal Med Residency Program, Pittsburgh, PA USA
[3] Univ Pittsburgh, Dept Family Med, Pittsburgh, PA 15260 USA
[4] UPMC Shadyside, Family Med Residency Program, Pittsburgh, PA USA
[5] Univ Pittsburgh, Med Ctr, Dept Med, Div Infect Dis, Pittsburgh, PA USA
关键词
Hepatitis C; Hepacivirus; Medical Ethics; Surveys and Questionnaires; VIRUS-INFECTION; UNITED-STATES; SOFOSBUVIR; PHYSICIANS; CAPACITY; NURSES;
D O I
10.3122/jabfm.2018.02.170220
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background and Objective: To determine whether family medicine program directors (PDs) experienced moral distress due to obstacles to Hepatitis C virus (HCV) treatment, and to explore whether they found those obstacles to be unethical. Design: An omnibus survey by the Council of Academic Family Medicine's Educational Research Alliance was administered to 452 and completed by 273 US-based PDs. The survey gauged attitudes and opinions regarding ethical dilemmas in patient access to HCV treatment. Results: Most of the respondents were male. Sixty-four percent of respondents believed that treatment should be an option for all patients regardless of cost. Forty-one percent believed that it was unethical to deny treatment based on past or current substance use, and 38% believed treatment should be offered to patients who were substance abusers. Moral distress was reported by 61% (score >3) of participants when they were unable to offer treatment to patients due to the patient's failure to meet eligibility criteria. In addition, PDs reporting moderate-to-high levels of moral distress were also likely to report the following opinions: 1) treatment should be offered regardless of cost, 2) it is unethical to deny treatment based on past behavior, 3) substance abusers should be offered treatment, 4) it is unethical for medicine to be prohibitively expensive, and 5) Medicaid policy that limits treatment will worsen racial and ethnic disparities. Conclusions: Currently, important ethical dilemmas exist in the access and delivery of HCV therapy. Although a diversity of opinions is noted, a significant proportion of PDs are concerned about patients' inability to avail equitable care and experience distress. In some cases, this moral distress is in response to, and in conflict with, current guidelines.
引用
收藏
页码:286 / 291
页数:6
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