Question
What are the possible ethical issues within the research study?
How might ethical concerns influence the research outcomes of this research study?
What is the research design validity, and how can research bias impact validity? (Hint: Research how design validity and instrumentation validity are different concepts.)
How could stakeholders potentially influence this health care research?
What conclusions can you draw about ethics and validity in the research process based on the research study?
Cancer treatment during pregnancy can raise many difficult questions. Currently available clinical practice guidelines offer very limited ethical guidance for healthcare professionals. This article offers a theoretical framework and a practical ethics checklist for ethical and patient-centered care. It takes a holistic view to patient treatment, care and counselling that emphasizes the need to recognize the relational context of individual patient's autonomy; balance maternal and fetal beneficence obligations; balance maternalistic and relational approaches to evidence-based personalized patient care; consider protection of the vulnerable in light of responsibilities towards the unborn; and ensure reasonable and just resource allocation. At the moment, very few studies have explored clinicians' attitudes and patients' experiences when cancer treatment is delivered during pregnancy. Therefore, future work will require patient engagement to develop ethical guidance in this setting. ( 1) Background: Caring for pregnant cancer patients is clinically and ethically complex. There is no structured ethical guidance for healthcare professionals caring for these patients. ( 2) Objective: This concept paper proposes a theoretically grounded framework to support ethical and patient-centered care of pregnant cancer patients. ( 3) Methodological approach: The framework development was based on ethical models applicable to cancer care during pregnancy—namely principle-based approaches (biomedical ethics principles developed by Beauchamp and Childress and the European principles in bioethics and bio law) and relational, patient-focused approaches (relational ethics, ethics of care and medical maternalism)—and informed by a systematic review of clinical practice guidelines. ( 4) Results: Five foundational discussion themes, summarizing the key ethical considerations that should be taken into account by healthcare professionals while discussing treatment and care options with these patients, were identified. This was further developed into a comprehensive ethics checklist that can be used during clinical appointments and highlights the need for a holistic view to patient treatment, care and counselling while providing ethical, patient-centric care. ( 5) Conclusion: The proposed framework was further operationalized into an ethics checklist for healthcare professionals that aims to help them anticipate and address ethical concerns that may arise when attending to pregnant cancer patients. Further studies exploring clinicians' attitudes towards cancer treatment in the course of pregnancy and patient experiences when diagnosed with cancer while pregnant and wider stakeholder engagement are needed to inform the development of further ethical, patient-centered guidance.
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