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Ethical Issues in Cardiology Patients' views of information and decision-making

Ågård, Anders LU (2005)
Abstract
The over-riding aim of this thesis was to obtain a deeper understanding of the way patients with cardiac problems view both information related to their health and medical decisions and their role in decision-making processes. An important objective was to identify reasons why patients do not ask for or assimilate information or why they do not want or feel that they are able to influence medical decisions.



The starting point for the investigations was five ethical problem areas in cardiology practice. They included (I) informing patients with heart failure about their diagnosis and treatment, (II) involving them in decision-making processes associated with cardiopulmonary resuscitation (CPR) and (III) implantable... (More)
The over-riding aim of this thesis was to obtain a deeper understanding of the way patients with cardiac problems view both information related to their health and medical decisions and their role in decision-making processes. An important objective was to identify reasons why patients do not ask for or assimilate information or why they do not want or feel that they are able to influence medical decisions.



The starting point for the investigations was five ethical problem areas in cardiology practice. They included (I) informing patients with heart failure about their diagnosis and treatment, (II) involving them in decision-making processes associated with cardiopulmonary resuscitation (CPR) and (III) implantable cardioverter defibrillators (ICD), (IV) obtaining informed consent from patients in the emergency phase of an acute myocardial infarction (AMI) and (V) informing and caring for patients without any obvious cause of chest pain.



A qualitative analysis of semi-structured interviews conducted with patients treated at Sahlgrenska University Hospital, Göteborg, was employed in all five studies.



The results indicate the following. Patients may regard themselves as being satisfactorily informed, even though they have a low level of knowledge and have unanswered questions. Several reasons for not requesting additional information, including prognostic information, or trying to improve knowledge were identified (I, V). For the majority of the respondents with heart failure, it was simply a matter of course that they wanted CPR and the question of whether CPR should be undertaken was therefore not regarded as a topic of immediate interest. In general, they wanted to discuss the issue but trusted the physicians to make the right final decision (II). The respondents who had received an ICD felt confident about opting for the treatment after being told that it was the best treatment for life-threatening arrhythmias. Very little criticism was directed at the lack of information and the lack of participation in decision-making processes, despite reports of incomplete information and a passive role in the decision (III). Those respondents who had been included in studies in connection with suffering an AMI had a very limited knowledge of the trial to which they had consented. They reported various problems related to the consent procedure in this particular situation (IV).



Ethical questions relating to patient information and patients? participation in decision-making were discussed in the light of the results obtained from the interviews and current empirical knowledge. Proposals for ways of dealing with the ethical problems raised in this thesis were made. (Less)
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author
supervisor
opponent
  • Professor Riis, Povl, Hellerup, Danmark
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Praktisk filosofi, estetik, metafysik, kunskapsteori, ideologi, ideology, decision-making, information disclosure, aesthetics, metaphysics, epistemology, ethics, Kardiovaskulära systemet, Systematic philosophy, Cardiovascular system, interview, atypical chest pain, acute myocardial infarction, cardiopulmonary resuscitation, implantable cardioverter defibrillator, heart failure, patient-caregiver communication, patient preference, informed consent
pages
87 pages
publisher
Department of Medical Ethics, Lund University
defense location
Hörsal 01, Vårdvetenskapens hus (Institutionen för hälsa, vård och samhälle)
defense date
2005-02-09 13:00:00
ISBN
91-628-6406-8
language
English
LU publication?
yes
additional info
A Ågård, G Hermerén and J Herlitz. 2004. When is a patient with heart failure adequately informed? A study of patients' experiences and preferences regarding medical information. Heart and Lung, vol 2004; 33:119-226. Elsevier
Anders Ågård, G Hermerén and J Herlitz. 2000. Should cardiopulmonary resuscitation be performed on patients with heart failure? The role of the patient in the decision-making process. Journal of Internal Medicine 2000;, vol 248 pp 279-286. Elsevier
Anders Ågård, G Hermerén and J Herlitz. 2001. Patients' experiences of inclusion in interventional trials regarding acute myocardial infarction. Is it time to adjust the informed consent procedure to the patients' capacity? Heart, vol 86 pp 632-637. BMJ Publisher Group
Anders Ågård, L Bentley and J Herlitz. . Experiences and concerns among patients being treated following a diagnosis of atypical chest pain. European Journal of Internal Medicine, (accepted)
A Ågård, R Löfmark, N Edvardsson and I Ekman. . Patients' views of their role in the decision to start ICD treatment: Prescription rather than participation? (submitted)
id
78114557-7015-4f6d-b920-1a23d21b8eae (old id 544252)
date added to LUP
2016-04-04 12:17:29
date last changed
2018-11-21 21:10:06
@phdthesis{78114557-7015-4f6d-b920-1a23d21b8eae,
  abstract     = {{The over-riding aim of this thesis was to obtain a deeper understanding of the way patients with cardiac problems view both information related to their health and medical decisions and their role in decision-making processes. An important objective was to identify reasons why patients do not ask for or assimilate information or why they do not want or feel that they are able to influence medical decisions.<br/><br>
<br/><br>
The starting point for the investigations was five ethical problem areas in cardiology practice. They included (I) informing patients with heart failure about their diagnosis and treatment, (II) involving them in decision-making processes associated with cardiopulmonary resuscitation (CPR) and (III) implantable cardioverter defibrillators (ICD), (IV) obtaining informed consent from patients in the emergency phase of an acute myocardial infarction (AMI) and (V) informing and caring for patients without any obvious cause of chest pain.<br/><br>
<br/><br>
A qualitative analysis of semi-structured interviews conducted with patients treated at Sahlgrenska University Hospital, Göteborg, was employed in all five studies.<br/><br>
<br/><br>
The results indicate the following. Patients may regard themselves as being satisfactorily informed, even though they have a low level of knowledge and have unanswered questions. Several reasons for not requesting additional information, including prognostic information, or trying to improve knowledge were identified (I, V). For the majority of the respondents with heart failure, it was simply a matter of course that they wanted CPR and the question of whether CPR should be undertaken was therefore not regarded as a topic of immediate interest. In general, they wanted to discuss the issue but trusted the physicians to make the right final decision (II). The respondents who had received an ICD felt confident about opting for the treatment after being told that it was the best treatment for life-threatening arrhythmias. Very little criticism was directed at the lack of information and the lack of participation in decision-making processes, despite reports of incomplete information and a passive role in the decision (III). Those respondents who had been included in studies in connection with suffering an AMI had a very limited knowledge of the trial to which they had consented. They reported various problems related to the consent procedure in this particular situation (IV).<br/><br>
<br/><br>
Ethical questions relating to patient information and patients? participation in decision-making were discussed in the light of the results obtained from the interviews and current empirical knowledge. Proposals for ways of dealing with the ethical problems raised in this thesis were made.}},
  author       = {{Ågård, Anders}},
  isbn         = {{91-628-6406-8}},
  keywords     = {{Praktisk filosofi; estetik; metafysik; kunskapsteori; ideologi; ideology; decision-making; information disclosure; aesthetics; metaphysics; epistemology; ethics; Kardiovaskulära systemet; Systematic philosophy; Cardiovascular system; interview; atypical chest pain; acute myocardial infarction; cardiopulmonary resuscitation; implantable cardioverter defibrillator; heart failure; patient-caregiver communication; patient preference; informed consent}},
  language     = {{eng}},
  publisher    = {{Department of Medical Ethics, Lund University}},
  school       = {{Lund University}},
  title        = {{Ethical Issues in Cardiology Patients' views of information and decision-making}},
  year         = {{2005}},
}