0909P- RESEARCH PROPOSAL: THE MAJORS MEDICAL ETHICAL CHALLENGES FACING THE PUBLIC AND HEALTH CARE PROVIDERS IN K. S. A

Research proposal:

The Majors Medical Ethical Challenges

Facing the public and health care

Providers in K. S. A

Principal Researcher: Dr Abdul Aziz Alkaabba

Co-Researchers:

  

PROPOSAL OUTLINE

 1. Introduction

 2.  Background

 3.  AIMS OF THE STUDY

I. general aim

          II. Specific objectives

 4. Literature Review

 5.  METHODOLGY. 

          I.   study area

          II.study population

          III. Study design

          IV. Study sample

          V.Stastical method 

6-Data collection and analysis

7-Timetable

8-Budget

9-Strength and Limitation of the study

10. Bibliography

1-INTRODUCTION

Many people in our culture in need of medical care such as diagnostic tests, appointments with Specialists, and surgical procedures are forced to wait months, and perhaps even years, to receive before receiving these services. Such problems here and around the world are manifestations of ethical challenges facing patients and their families in the health care setting. It is very important to introduce medical ethics to the health system and to make sure that there are good and ethical health care providers to avoid such ethical problems. There are many challenges to introducing good medical ethics services everywhere. For our society, it is important to identify ethical issues facing health care providers and the public. Ranking the top ethical challenges facing the public can be an effective and valuable way of bringing them to public attention. According to the best of our knowledge there is no study in our culture on identifying and ranking the most important ethical issues. This study will be the first to focus on identifying the major ethical issues facing health care providers and the public in our country. By the end of this research we shall be aware of the most important and major ethical issues in K.S.A. and also understanding and managing them as well as comparing our results with similar international studies.

2-BACKGROUND ABOUT K.S.A:

The Kingdom of Saudi Arabia is large country with a total population of 25 million. There are many health institutions in KSA providing health services to civilian and military populations.  Riyadh, the largest city in KSA and the Arabian Gulf Region, is the capital. Its population is more than 5 million. It contains major heath institutions: large hospitals and medical colleges. Jeddah, the second largest city, has a population of more than 2 million. It also contains major hospitals and medical colleges. Dammam, the third largest city with an estimated population of 1.5 million, like Riyadh and Jeddah also has medical institutions and colleges.

3- LITERATURE REVIEW.

Although medical ethical challenges have been discussed widely in the literature as isolated ethical issues in health care, there are few papers published internationally concerned with identifying major ethical issues facing the public. One of the most important studies was carried out in Ontario, Canada. A modified Delphi study was conducted with twelve clinical bioethicists who were members of the Clinical Ethics Group of the University of Toronto Joint Centre for Bioethics. The panel was asked the question 'what do you think are the top ten ethical challenges that Canadians may face in health care? They were asked to rank the top ten ethical challenges throughout the Delphi process and consensus was reached after three rounds. (2). The top 10 ethical issues identified by the panel were: (a) Disagreement between patients/families and health care professionals about treatment decisions (b) Waiting lists (c) Access to needed health care resources for the aged, chronically ill and mentally ill (d) Shortage of family physicians or primary care teams in both rural and urban settings (e) Medical errors. (f) Withholding/withdrawing life sustaining treatment in the context of terminal or serious illness. (g) Achieving informed consent. (h) Ethical issues related to subject participation in research. (i) Substitute decision-making. (j) the ethics of surgical innovation and incorporation new technologies for patient care. (2). Although many of the challenges listed by the panel have received significant public attention, it is important to know that we expect different result in our study because of different culture and system.

A study was carried out aimed at describing highly important ethical issues to oncology nurses and to discuss strategies by which the Oncology Nursing Society (ONS) could address these concerns. Nine priorities ethical Issues of oncology nurses are identified. Past, current, and future ONS activities that address these priority issues were discussed. The study concluded that the top three priority ethical issues for oncology nurses were: assisted suicide, end-of-life decisions, and pain management. A recommendation was made that efforts should be made to increase ethics expertise among the memberships) (4).

A study concerned about Physicians' and Nurses' Perceptions of Ethics Problems on General Medical Services (3) was aiming at understanding the kinds of clinical situations physicians and nurses regard as "ethics problems". The authors prospectively studied physicians' and nurses' perceptions of ethics problems using paired interviews. Individual interviews were conducted with physicians and nurses as they cared for the same patients during a six-week period. Each participant in the study was asked whether any ethics problems had arisen in the care of his or her patients and, if so, to give a brief description of each problem. Three general medical services in a 497-bed community teaching hospital were involved. Participants were 13 physicians and 42 nurses caring for 142 patients. The study showed that physicians and nurses considered a broad range of clinical situations to be "ethics problems," and they perceived them to occur frequently. Systematic differences were found between physicians' and nurses ‘perceptions of ethics problems, and many ethical problems generated inter staff conflicts. Incorporating this kind of information into clinical ethics education programs, and into hospital policies, may represent a useful approach toward improving physician-nurse interaction.

4 -AIMS OF THIS STUDY

The aim of this study is: to explore the major medical ethical issues and challenges facing the public and health care providers in K.S.A and to compare our result with similar international studies.

5- METHODOLGY.                                   

Study area:  The study will be carried out in the cities of Riyadh, Jeddah, and Dammam.

Study population: The study population will be all members of ethics committees in the majors health institutions (hospitals) who teach or have experience in the medical ethics field. A randomly chosen sample of 8 ethics committees in major hospitals will be selected: 4 in Riyadh, 2 in Jeddah, and 2 in Dammam. A modified Delphi study will be conducted with a panel of 10 committee members who are qualified in ethics. Qualified ethicists are preferred to the general community because they experience a wider range of ethical problems in their work.

Study design: This is a cross-section quantitative study.

Study sample: All members of ethics committees in the 8 hospitals in Riyadh, Jeddah and Dammam will participate in this study the total number needed being between 50-100 participants who have a high familiarity with the overall range of medical ethical challenges which are highly concentrated in their day to day work. The large hospitals included will be (a) in Riyadh: King Fahd Medical City (KFMC), the National Guard Hospital (KFNGH), the Military Hospital (RKH), and the King Khalid University Hospital (KKUH). (b) In Jeddah: King Fahd hospital and King Abdul-Aziz University hospital. (c) In Dammam: The Central Hospital and the Aramco Hospital.

Data collection: This study will use Delphi method which is validated and was used in a similar international study in Canada. It requires three rounds to get a good result. In the first round participants in each hospital in a meeting with the researcher will be asked to write their own list of top ethical issues challenging health care provider in our culture. Then these forms will be collected and the issues will be ranked according to frequency. In the second round the ranked issues collected in the first round will be sent by e-mail to all study participants and they will be asked to rank the ten top issues again and send their results by email to the researcher. The participants I each city will be invited to a meeting at which the results of the second round will be discussed and the top 10 issues will be chosen. After getting the opinion of the Supreme Health Legal Authority, the final list top 10 will be compared with the international result.

Statistical Analysis: Data will be entered and analyzed using SPSS version 16. Descriptive statistics will be used for all items. Scores for each section, will be summed to create a sub-score for each section and a total score for all sections.  For each section the items will be ranked according to the highest score. The highest 10 ranked items will be considered as the top 10 ethical issues needed to be addressed.

6- STRENGTH AND LIMITATION OF THE STUDY

This study will be the first focussed on major ethical issues that face our public and community. One of the strengths is that the selected participants will represent different academic and medical staff and also administration. The results of this study will be compared to the study done in Ontario in Canada and we suspect differences in the ranking of the major ethical issues because of different culture and health care system in our community. One of limitation will be the communication with the people whom will share in the study.

7-TIMETABLE:

Basically we need to finish this project within three-six months after the agreement of the responsible people and the detail Timetable will be in explained in that time.

8-BUDGET:

This will be arranging with committee which is responsible for that issue.

9- REFERENCES.

1- King Fahd Medical City, Riyadh, KSA www.kfmc.med.sa

2- Jonathan M Breslin Susan KMacrae : top 10 health care ethics challenges facing public .

BMC MEDICAL ETHICS 2005,JUNE6:5 PUB MED.

3-Walker RM, Miles SH, Stocking CB, Siegler M: Physicians' and Nurses' Perceptions o of Ethics Problems on General Medical Services.

Journal of General Internal Medicine 1991, 6:424-9. Pub Med Abstract

Return to text

4– REFERENCES Ersek M, Scanlon C, Glass E, Ferrell BR, Sleeves R: Priority Ethical Issues in Oncology Nursing: Current Approaches and Future Directions.

Oncology Nursing Forum 1995, 22:803-7. Pub Med Abstract Return to text