Year 2020 / Volume 27 / Number 2

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Ethical problems in the management of pain. Qualitative study through open reflection interview

Rev. Soc. Esp. Dolor. 2020; 27(2): 89-96 / DOI: 10.20986/resed.2020.3729/2019

Jaime Boceta, Ana Peiró, F. Javier Cevas, Loreto Mª Vidal, Marisol Acedo, Víctor Mayoral


ABSTRACT

Introduction: The medical practice in the area of pain associates ethical problems in the care of patients with a disease that causes a functional deterioration, with an uncertain prognosis for their labor reintegration, and a great consumption of family and social resources. After the creation of a working group on bioethics within the Spanish Pain Society (SPS), an attempt is made to analyze these problems.
Objective: To know which are the ethical problems that identify professionals (clinical practice, environment and institutions) which concerns SPS members; encouranging an ethical reflection.
Methodology: Qualitative study, based on a semistructured, open interview, send to members of the SPS (n = 1035), through electronic access, on 4 bioethical aspects: the problems detected in clinical practice, the problems of the work environment, the problems in the work organizations, and possible suggestions. These are grouped as they refer to the indications (beneficence and non-maleficence), justice (understood as equity), autonomy (information and preferences).
Results: A total of 6 % professionals participated in the interview (n = 62/1035). A panel was prepared with the 10 main issues identified. They emphasize the uncertainty in the taking of decisions in the therapeutic, the limitation of the therapeutic effort, the conditioning of the sanitary system, the relations with the pharmaceutical industry and the search of the excellence.
Conclusions: This qualitative study allows identifying ethical problems that interest professionals dedicated to pain. It is convenient to confirm and size them through quantitative studies.



RESUMEN

Introducción: La práctica médica en el área del dolor plantea problemas éticos en la atención a pacientes con una enfermedad que provoca un deterioro funcional, con un pronóstico incierto para su reinserción laboral, y gran consumo de recursos familiares y sociales. Tras la creación de un grupo de trabajo en bioética dentro de la Sociedad Española del Dolor (SED) se intenta analizar dichos problemas.
Objetivo: Conocer los problemas éticos relacionados con el manejo del dolor (práctica clínica, entorno e instituciones) que preocupan a los profesionales miembros de la SED, así como fomentar una reflexión ética.
Metodología: Estudio cualitativo, basado en una entrevista semiestructurada, abierta, enviada a los miembros de la SED (n = 1035), mediante acceso electrónico, sobre 4 aspectos bioéticos: los problemas detectados en la práctica clínica, los problemas del entorno de trabajo, los problemas en las organizaciones de trabajo, y posibles sugerencias. Estos se agrupan según se refieran a las indicaciones (beneficencia y no maleficencia), la justicia (entendida como equidad) o la autonomía (información y preferencias).
Resultados: Participaron en la entrevista un 6 % de los profesionales (n = 62/1035). Se elaboró un panel con las 10 cuestiones principales identificadas. Destacan la incertidumbre en la toma de decisiones en la terapéutica, la limitación del esfuerzo terapéutico, los condicionamientos del sistema sanitario, las relaciones con la industria farmacéutica y la búsqueda de la excelencia.
Conclusiones: Este estudio cualitativo permite identificar problemas éticos que interesan a los profesionales dedicados al dolor. Es conveniente confirmarlos y dimensionarlos mediante estudios cuantitativos.





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Bibliografía

1. Carmona L, Ballina J, Gabriel R, Laffon A; EPISER Study Group. The burden of musculoskeletal diseases in the general population of Spain: results from a national survey. Ann Rheum Dis. 2001;60(11):1040-5. DOI: 10.1136/ard.60.11.1040.
DOI: 10.1136/ard.60.11.1040
2. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287-333. DOI: 10.1016/j.ejpain.2005.06.009.
DOI: 10.1016/j.ejpain.2005.06.009
3. Katz N. The impact of pain management on quality of life. J Pain Symptom Manage. 2002;24 (1 Suppl):S38-47. DOI: 10.1016/S0885-3924(02)00411-6.
DOI: 10.1016/S0885-3924(02)00411-6
4. Remmers PA, Speer AJ. Clinical strategies in the medical care of Jehovah’s witnesses. Am J Med 2006;119(12):1013-8. DOI: 10.1016/j.amjmed.2006.04.016.
DOI: 10.1016/j.amjmed.2006.04.016
5. Grupo de trabajo Sociedad Española del Dolor. Bioética [acceso: 28 Nov 2016]. Disponible en: www.sed.es
6. De Cossart L, Fish D, Hillman K. Clinical reflection: A vital process for supporting the development of wisdom in doctors. Curr Opin Crit Care 2012;18(6):712-7 DOI: 10.1097/MCC.0b013e328358e239.
DOI: 10.1097/MCC.0b013e328358e239
7. Plack MM, Driscoll M, Blissett S, McKenna R, Plack TP. A method for assessing reflective journal writing. J Allied Health. 2005;34(4):199-208.
8. Mann KV. Reflection: understanding its influence in practice. Med Educ. 2008;42(5):449-51. DOI: 10.1111/j.1365-2923.2008.03081.x.
DOI: 10.1111/j.1365-2923.2008.03081.x
9. Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002;287(2):226-35. DOI: 10.1001/jama.287.2.226.
DOI: 10.1001/jama.287.2.226
10. Gracey CF, Haidet P, Branch WT, Weissmann P, Kern DE, Mitchell G, et al. Precepting humanism: Strategies for fostering the human dimensions of care in ambulatory settings. Acad Med. 2005;80(1):21-8. DOI: 10.1097/00001888-200501000-00007.
DOI: 10.1097/00001888-200501000-00007
11. Branch WT Jr, Kern D, Haidet P, Weissmann P, Gracey CF, Mitchell G, et al. Teaching the human dimensions of care in clinical settings. JAMA. 2001;286(9):1067-74. DOI: 10.1001/jama.286.9.1067.
DOI: 10.1001/jama.286.9.1067
12. Gracia-Guillén D. Teoría y práctica de la deliberación moral. En: Lydia Feito L, Gracia D, Sánchez M, editores. Bioética: el estado de la cuestión. Madrid: Ed. Triacastela; 2011. p. 101-54.
13. Gracia D. Deliberation and consensus. En: Chadwick R, ten Have H, Meslin EM, editores. The SAGE handbook of health care ethics: Core and emerging issues. London: SAGE Publications Ltd; 2011. p.84-94. DOI: 10.4135/9781446200971.n9.
14. Anwari JS. Medical ethics and chronic pain management. Saudi Med J. 2008;29(6):921-2.
15. Rich BA, Dubois M. Pain, ethics, and public policy. Pain Med. 2011;12(9):1295-6. DOI: 10.1111/j.1526-4637.2011.01219.x.
DOI: 10.1111/j.1526-4637.2011.01219.x
16. Pérez-Castañeda T. Aspectos bioéticos en el manejo del dolor por cáncer [acceso: 12 Mar 2017]. Disponible en: www.cbioetica.org/revista/102/102-0914.pdf
17. Kwon JH, Hui D, Bruera E. A pilot study to define chemical coping in cancer patients using the Delphi method. J Palliat Med. 2015;18(8):703-6.
DOI: 10.1089/jpm.2014.0446
18. Boceta J, de la Torre A, Samper D, Farto M, Sánchez-de la Rosa R. Consensus and controversies in the definition, assessment, treatment and monitoring of BTcP: results of a Delphi study. Clin Transl Oncol. 2016;18(11):1088-97.
DOI: 10.1007/s12094-016-1490-4

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Boceta J, Peiró A, Cevas F, Vidal L, Acedo M, Mayoral V, et all. Ethical problems in the management of pain. Qualitative study through open reflection interview. Rev Soc Esp Dolor 2020; 27(2): 89-96 / DOI: 1020986/resed20203729/2019


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Ficha Técnica

Recibido: 23/02/2019

Aceptado: 03/02/2020

Prepublicado: 16/03/2020

Publicado: 17/04/2020

Tiempo de revisión del artículo: 314 días

Tiempo de prepublicación: 387 días

Tiempo de edición del artículo: 419 días


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