This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view (...) of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective. (shrink)

Die spezifischen Anforderungen riskanter Entscheidungslagen stellen die Medizinethik zunehmend vor die Herausforderung, normative Modelle der Risikokommunikation zu etablieren. Dabei geht es freilich nicht nur darum, Informationen über die Wahrscheinlichkeiten, mit denen bestimmte Ereignisse eintreten, bereitzustellen. Zur medizinischen Aufklärung gehört auch, dass Risiken verständlich kommuniziert werden. Andernfalls würde ein Patient zwar über Informationen verfügen, wäre aber nicht in der Lage, sie richtig zu interpretieren und zu bewerten. Der Beitrag stellt am Beispiel von Mammographie-Screenings Probleme der transparenten Kommunikation medizinischer Risiken dar. Diese (...) betreffen zum einen Informationen, die Ärztinnen und Ärzten in medizinischen Fachzeitschriften, zum anderen Informationen, die interessierten oder betroffenen Frauen in Broschüren vermittelt werden. Diese Schwierigkeiten der Risikokommunikation können teils durch institutionelle Lösungen, teils durch Aufklärung überwunden werden. (shrink)

Background:An ethical, informed consent process requires that potential participants understand the study, their rights, and the risks and benefits. Yet, despite strategies to improve communication, many participants still lack understanding of potential risks and benefits. Investigating attitudes and practices of research nurses can identify ways to improve the informed consent process.Research question:What are the attitudes, practices, and preparedness of nurses involved in the informed consent process regarding communication of risks and benefits?Research design:A survey was developed and administered online to a (...) national purposive sample of 107 research nurses with experience obtaining informed consent for clinical trials. Survey responses stratified by selected work-related characteristics were analyzed.Ethical considerations:Participants were instructed they need not answer each question and could stop at any time. They consented by clicking “accept” on the email which linked to the survey. The study was approved by the Northeastern University Institutional Review Board, Boston, Massachusetts.Findings:Most research nurses used a teach-back method to assess participant comprehension, while 72% relied on their intuition. About one-third did not feel prepared to communicate related statistics. About 20% did not feel prepared to tailor information, and half did not feel competent using supplemental materials to enhance risks and benefits comprehension. Only 70% had received training in the informed consent process which included in-person training, case studies, online courses, feedback during practice sessions, and simulation, such as role playing and viewing videos. Perceived preparedness was significantly associated with greater informed consent experience and training.Conclusion:Research nurses may have inadequate training to encourage, support, and reinforce communication of risks and benefits during the informed consent process. Relevant purposeful education and training should help to improve and standardize the ethical informed consent process. (shrink)