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2. Lying to patients with dementia: Attitudes versus behaviours in nurses.

Author

Cantone, Daniela, Attena, Francesco, Cerrone, Sabrina, Fabozzi, Antonio, Rossiello, Riccardo, Spagnoli, Laura, and Pelullo, Concetta Paola

Subjects
*BEHAVIOR, *CHI-squared test, *CONFIDENCE intervals, *DECEPTION, *DEMENTIA patients, *EPIDEMIOLOGICAL research, *NURSES' attitudes, *NURSING ethics, *QUESTIONNAIRES, *CROSS-sectional method, *DATA analysis software, *DESCRIPTIVE statistics, *PSYCHOLOGICAL factors
Abstract

Background: Using lies, in dementia care, reveals a common practice far beyond the diagnosis and prognosis, extending to the entire care process. Objectives: In this article, we report results about the attitude and the behaviour of nurses towards the use of lies to patients with dementia. Research design: An epidemiological cross-sectional study was conducted between September 2016 and February 2017 in 12 elderly residential facilities and in the geriatric, psychiatric and neurological wards of six specialised hospitals of Italy's Campania Region. Participants: In all, 106 nurses compiled an attitude questionnaire (A) where the main question was 'Do you think it is ethically acceptable to use lies to patients with dementia?', instead 106 nurses compiled a behaviour questionnaire (B), where the main question was 'Have you ever used lies to patients with dementia?' Ethical considerations: Using lies in dementia care, although topic ethically still controversial, reveals a common practice far beyond the diagnosis and prognosis, extending to the entire care process. Findings: Only a small percentage of the interviewed nurses stated that they never used lies/that it is never acceptable to use lies (behaviour 10.4% and attitude 12.3%; p = 0.66). The situation in which nurses were more oriented to use lies was 'to prevent or reduce aggressive behaviors'. Indeed, only the 6.7% in the attitude group and 3.8% in the behaviour group were against using lies. On the contrary, the case in which the nurses were less oriented to use lies was 'to avoid wasting time giving explanations', in this situation were against using lies the 51.0% of the behaviour group and the 44.6% of the attitude group. Conclusion: Our results, according to other studies, support the hypothesis of a low propensity of nurses to ethical reflection about use of lies. In our country, the implementation of guidelines about a correct use of lie in the relationship between health operators and patients would be desirable. [ABSTRACT FROM AUTHOR]

Published
2019
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3. Too much medicine? Scientific and ethical issues from a comparison between two conflicting paradigms

Author

Francesco Attena and Attena, Francesco

Subjects
Systems Analysis, Debate, media_common.quotation_subject, Population, Harm-benefit assessment, 030209 endocrinology & metabolism, Breast Neoplasms, Systems Analysi, Risk Assessment, Scarcity, Conflict, Psychological, 03 medical and health sciences, 0302 clinical medicine, Medicine, Humans, Conflict (Psychology), Ethics, Medical, Ethic, 030212 general & internal medicine, Overdiagnosis, education, Breast cancer screening, Competence (human resources), Health policy, Early Detection of Cancer, media_common, Ethics, education.field_of_study, Evidence-Based Medicine, business.industry, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Paradigm, Systems medicine, Incommensurability, Engineering ethics, Female, Disconnection, Biostatistics, business, Breast Neoplasm, Human, Too much medicine
Abstract

Background The role of medicine in society appears to be focused on two views, which may be summarized as follows: “Doing more means doing better” (paradigm A) and “Doing more does not mean doing better” (paradigm B). Main body I compared paradigms A and B both in terms of a single clinical condition and in the general context of a medical system. For a single clinical condition, I analyzed breast cancer screening. There are at least seven interconnected issues that influence the conflict between paradigms A and B in the debate on breast cancer screening: disconnection between research and practice; scarcity of information given to women; how “political correctness” can influence the choice of a health policy; professional interests; doubts about effectiveness; incommensurability between harms and benefits; and the difficulty in making dichotomous decisions with discrete variables. As a general approach to medicine, the main representative of paradigm A is systems medicine. As representatives of paradigm B, I identified the following approaches or movements: choosing wisely; watchful waiting; the Too Much Medicine campaign; slow medicine; complaints against overdiagnosis; and quaternary prevention. I showed that both as a single condition and as a general approach to medicine, the comparison was entirely reducible to a harm-benefit analysis; moreover, in both cases, the two paradigms are in many respects incommensurable. This transfers the debate to the ethical level; consequently, scientists and the public have equal rights and competence to debate on this subject. Moreover, systems medicine has many ethical problems that could limit its spread. Conclusion I made some hypotheses about scenarios for the future of medicine. I particularly focused on whether systems medicine would become increasingly accessible and widespread in the population or whether it would be downsized because its promises have not been maintained or ethical problems will become unsustainable.

Published
2019

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