Browsing by Author "Dittborn, Mariana"

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    Clinical ethics support services in paediatric practice: protocol for a mixed studies systematic review on structures, interventions and outcomes
    (2022) Dittborn, Mariana; Portales, María Bernardita; Brierley, Joe
    Introduction Clinical ethics support services (CESS) have been developing worldwide with growing interest in evaluating their quality. Paediatric-specific CESSs (p-CESS) have received little attention, and evidence from adult services might not be generalisable. Evidence on service models and practices is crucial to inform further research and debate on quality evaluation and minimum standards for p-CESSs. We aim to systematically identify, appraise and synthesise evidence for p-CESS structures, processes and outcomes. Methods and analysis: We will conduct a mixed-studies systematic review including peer-reviewed empirical Studies published in English or Spanish language providing data on the evaluation and/or impact on any aspect of p-CESS. We will search seven electronic databases: MEDLINE, Philosopher’s Index, EMBASE, PsycINFO, LILACS, Web of Science and CINHAL, without filters applied. Search terms will be related to “clinical ethics support” AND “paediatrics” AND “structure/process/outcome”. Reference and citation list of included studies will be handsearched. A 10% random sample of retrieved titles/abstracts and all full texts will be independently dual-screened. We will conduct narrative and thematic synthesis for quantitative and qualitative data, respectively, following sequential explanatory synthesis guided by Donabedian’s framework of structure, process and outcomes. Quality will be assessed using the Mixed-Methods Appraisal Tool (2018). The review will be reported using the adapted Preferred Reporting Items for Systematic Reviews and Meta-Analyses for reporting systematic reviews of qualitative and quantitative evidence template. Stakeholders will be involved twice in the review process; prior to data extraction and synthesis and after preliminary results. Ethics and dissemination As a systematic review of published data, no ethical approval is necessary. Results will be published in a relevant academic peer-reviewed journal.
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    Ethical Challenges Experienced by Healthcare Workers Delivering Clinical Care during Health Emergencies and Disasters: A Rapid Review of Qualitative Studies and Thematic Synthesis
    (2022) Dittborn, Mariana; Micolich, Constanza; Rojas, Daniela; Salas, Sofía
    Background: The COVID-19 pandemic has posed several ethical challenges worldwide. Understanding care providers' experiences during health emergencies is key to develop comprehensive ethical guidelines for emergency and disaster circumstances.Objectives: To identify and synthetize available empirical data on ethical challenges experienced by health care workers (HCWs) providing direct patient care in health emergencies and disaster scenarios that occurred prior to COVID-19, considering there might be a significant body of evidence yet to be reported on the current pandemic.Methods: A rapid review of qualitative studies and thematic synthesis was conducted. Medline and Embase were searched from inception to December 2020 using "public health emergency" and "ethical challenges" related keywords. Empirical studies examining ethical challenges experienced by frontline HCWs during health emergencies or disasters were included. We considered that ethical challenges were present when participants and/or authors were uncertain regarding how one should behave, or when different values or ethical principles are compromised when making decisions.Outcome: After deduplication 10,160 titles/abstracts and 224 full texts were screened. Twenty-two articles were included, which were conducted in 15 countries and explored eight health emergency or disaster events. Overall, a total of 452 HCWs participants were included. Data were organized into five major themes with subthemes: HCWs' vulnerability, Duty to care, Quality of care, Management of healthcare system, and Sociocultural factors.Conclusion: HCWs experienced a great variety of clinical ethical challenges in health emergencies and disaster scenarios. Core themes identified provide evidence-base to inform the development of more comprehensive and supportive ethical guidelines and training programmes for future events, that are grounded on actual experiences of those providing care during emergency and disasters.
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    Legalización de muerte médicamente asistida: discusión sobre el potencial impacto en el desarrollo de cuidados paliativos
    (2020) Dittborn, Mariana; Micolich V., Constanza
    In Chile, there are four bills to legalize euthanasia, an act which public surveys report as supported by most of the population. At the legislative, healthcare and social level, there is an active debate about euthanasia, the rights of terminally ill patients and the context of Palliative Care (PC) in the country. Chilean literature on euthanasia focuses mainly on the ethical analysis of the act itself but does not address the moral legitimacy of the legalization of this practice. This distinction is relevant since the probity of a particular action does not determine the moral legitimacy of its implementation at a public policy level. One aspect of this dimension is the potential negative impact of the legalization of physician-assisted death (PAD) on the development of PC services. This issue is particularly relevant in Chile, where PC provision is currently suboptimal and mostly restricted to cancer patients. This paper analyses available evidence on the potential impairment of PC development after PAD legalization. Although the analysis of evidence has some limitations, this concern is not supported by the available evidence. However, any project about PAD legalization must contemplate a factual commitment with the development of minimum PC provision, according to international recommendations.
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    Voluntades Anticipadas en Chile: conocimientos y actitudes de profesionales que trabajan en cuidados paliativos
    (Universidad del Desarrollo. Facultad de Medicina. Centro de Bioética, 2017-05) Dittborn, Mariana; Astete, Carmen
    Introducción: Las Voluntades Anticipadas corresponden a una herramienta recomendada para la toma de decisiones en salud al final de la vida. Se fundamentan principalmente en el reconocimiento de la dignidad de las personas y el derecho derivado a la autodeterminación o principio de respeto por la autonomía. En nuestro país no son reconocidas jurídicamente y no existen estudios que revelen mayor información sobre la realidad de conocimientos, percepciones y aplicaciones de las Voluntades Anticipadas en nuestro medio. Objetivo: Explorar los conocimientos y actitudes de profesionales (médicos, enfermeros, psicólogos) que se desempeñan en cuidados paliativos de adultos sobre las Voluntades Anticipadas. Diseño: Estudio descriptivo transversal por medio de un cuestionario Muestra: muestra voluntaria entre profesionales médicos, enfermeros y psicólogos de las Unidades de Cuidados Paliativos y Alivio del Dolor (CPyAD) del sistema de salud público de la Región Metropolitana. Instrumento: cuestionario anónimo autoaplicado diseñado por la investigadora. Resultados principales: Se distribuyeron 107 cuestionarios, con una tasa de respuesta de 76,6%. Un 45,1% (37) de los participantes es médico, el 34,1% (28) enfermero y un 20,7% (17) psicólogo, con una media de edad de 40,4 ± 12 años. El 98,8% refieres estar muy de acuerdo (79%) o de acuerdo (19,8%) con que es conveniente para las personas planificar y escribir sus deseos en relación a la atención de salud para los cuidados de final de la vida. Un 89% declara haber escuchado alguno de los tres términos –Voluntades Anticipadas, Testamento Vital o Directrices Previas-, siendo el término Voluntades Anticipadas reconocido con mayor frecuencia, con un 87% de declaración positiva. Sobre conocimientos, el 64,6% (53) de los participantes contestó menos de 4 preguntas correctas y un 35,4% (29) contestaron 4 o más preguntas correctas, de un total de 6 preguntas. El 70,8% responde acertadamente a la definición considerada más apropiada. Conclusiones: Los resultados demuestran una actitud positiva de los participantes hacia la planificación de cuidados al final de la vida. Las barreras y dificultades para su implementación son reconocidas por los participantes, existiendo prácticamente un consenso sobre su importancia en la práctica clínica. Se observa un alto reconocimiento del término Voluntades anticipadas, que se contrasta con un nivel de conocimiento relativamente bajo sobre elementos específicos y legislativos de las mismas

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