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Ethical dilemmas in physicians’ consultations with COPD patients

Ethical dilemmas in physicians’ consultations with COPD patients


Title: Ethical dilemmas in physicians’ consultations with COPD patients
Author: Sigurgeirsdóttir, Jónína
Halldórsdóttir, Sigríður
Arnardóttir, Ragnheiður Harpa   orcid.org/0000-0003-0670-8248
Guðmundsson, Gunnar
Bjornsson, Eythor Hreinn
Date: 2022
Language: English
Scope: 15
University/Institute: University of Akureyri
School: School of Health Sciences
Department: Faculty of Medicine
Internal Medicine and Emergency Services
Series: International Journal of COPD; 17()
ISSN: 1176-9106
DOI: https://doi.org/10.2147/COPD.S356107
Subject: Langvinn lungnateppa; Lungnaþemba; Lungnasjúkdómar; Sjúklingar; Læknar; COPD; interviews; motivation; patient education; physician-patient relations; physicians; physician’s role; qualitative research; self-management; Pulmonary and Respiratory Medicine; Health Policy; Public Health, Environmental and Occupational Health
URI: https://hdl.handle.net/20.500.11815/3270

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Citation:

Sigurgeirsdóttir , J , Halldórsdóttir , S , Arnardóttir , R H , Guðmundsson , G & Bjornsson , E H 2022 , ' Ethical dilemmas in physicians’ consultations with COPD patients ' , International Journal of COPD , vol. 17 , pp. 977-991 . https://doi.org/10.2147/COPD.S356107

Abstract:

 
Aim: This phenomenological study was aimed at exploring principal physicians’ (participants’) experience of attending to COPD patients and motivating their self-management, in light of the GOLD clinical guidelines of COPD therapy. Methods: Interviews were conducted with nine physicians, who had referred patients to PR, five general practitioners (GPs) and four lung specialists (LSs). The interviews were recorded, transcribed, and analyzed through a process of deconstruction and reconstruction. Results: The participants experienced several ethical dilemmas in being principal physicians of COPD patients and motivating their self-management; primarily in the balancing act of adhering to the Hippocratic Oath of promoting health and saving lives, while respecting their patients’ choice regarding non-adherence eg, by still smoking. It was also a challenge to deal with COPD as a nicotine addiction disease, deal with patients’ denial regarding the harm of smoking and in motivating patient mastery of the disease. The participants used various strategies to motivate their patients’ self-management such as active patient education, enhancing the patients’ inner motivation, by means of an interdisciplinary approach, involving the patients’ significant other when appropriate, and by proposing PR. Conclusion: The findings indicate that being a principal physician of COPD patients and motivating their self-management is a balancing act, involving several dilemmas. Patients’ nicotine addiction and physicians’ ethical obligations are likely to create ethical dilemmas as the physician is obligated to respect the patients’ will, even though it contradicts what is best for the patient. The participants suggest strategies to motivate COPD patients’ self-management.
 
Aim: This phenomenological study was aimed at exploring principal physicians’ (participants’) experience of attending to COPD patients and motivating their self-management, in light of the GOLD clinical guidelines of COPD therapy. Methods: Interviews were conducted with nine physicians, who had referred patients to PR, five general practitioners (GPs) and four lung specialists (LSs). The interviews were recorded, transcribed, and analyzed through a process of deconstruction and reconstruction. Results: The participants experienced several ethical dilemmas in being principal physicians of COPD patients and motivating their self-management; primarily in the balancing act of adhering to the Hippocratic Oath of promoting health and saving lives, while respecting their patients’ choice regarding non-adherence eg, by still smoking. It was also a challenge to deal with COPD as a nicotine addiction disease, deal with patients’ denial regarding the harm of smoking and in motivating patient mastery of the disease. The participants used various strategies to motivate their patients’ self-management such as active patient education, enhancing the patients’ inner motivation, by means of an interdisciplinary approach, involving the patients’ significant other when appropriate, and by proposing PR. Conclusion: The findings indicate that being a principal physician of COPD patients and motivating their self-management is a balancing act, involving several dilemmas. Patients’ nicotine addiction and physicians’ ethical obligations are likely to create ethical dilemmas as the physician is obligated to respect the patients’ will, even though it contradicts what is best for the patient. The participants suggest strategies to motivate COPD patients’ self-management.
 

Description:

Funding Information: The Oddur Olafsson Scientific Research Fund at the Reykjalundur Rehabilitation Institute, and the B-section of the Science Fund of the Icelandic Nurses’ Association funded the study. Publisher Copyright: © 2022 Sigurgeirsdottir et al.

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