How do healthcare professionals manage ethical challenges regarding information in healthcare professional/patient clinical interactions? A review of concept- or argument-based articles and case analyses

Abstract

ARTICLE This study is part of an ongoing project that is focused on enhancing health professionals' skills in managing the ethical challenges around information management in health professional-patient consultative encounters. Information management, following Swaminath, [1] is here taken to mean the power of a health professional to control the information that is disclosed to or withheld from patients. It is not always clear how information should be managed within the clinical context-for example, whether one should disclose or not disclose it, or whether one should tell the truth, or lie or conceal information. Certain guidelines, such as the Australian Code of Conduct for Doctors, [2,3] generally require physicians, for example, to disclose full and accurate information that has significant welfare implications, whether health-related or psychological, to their patients. Such disclosure, it is believed, would greatly strengthen patients' autonomy and significantly enhance their informed decision-making capacity. This obligation is a matter of ethics and law. Other guidelines, such as the Health Professions Council of South Africa's Guidelines for Good Practice in the Healthcare Professions (Booklet 4 (3:3)) [4] exist, which permit a physician to withhold information in circumstances where disclosure is medically contraindicated. Disclosure is medically contraindicated if it would cause a depressed patient, for example, to become actively suicidal, or compromise a patient's recovery process, for example, telling a hypertensive patient receiving critical care in an intensive-care unit that his/her spouse has just died. Notwithstanding the above, certain clinical situations still exist-such as when information regarding misattributed paternity is accidentally discovered in a health professional-patient consultative encounter-where deciding what course of action to take (disclosure or non-disclosure) may prove extremely difficult. On the one hand, disclosure of misattributed paternity information when a patient has not requested such information (and where establishing paternity is not the purpose of the patient's clinical interaction with the This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Background. This study forms part of an ongoing research project that seeks to enhance the information-management skills of health professionals within the clinical context. Objectives. To review case analyses and reviews and argument-based articles that use evidence and facts to prove whether or not a thesis is true. Specifically, this study attempts to provide a comprehensive overview of how health professionals manage information and related ethical challenges within the clinical context. Method. We carried out a literature search in PubMed and PhilPapers, using two search strings. All searches generated 954 hits. After screenings for year of publication, language, title and abstracts, duplicates and full-text reading, three more articles were identified following a system update in PubMed. A total of 53 articles were finally included for review. We used the Q-sort technique for the analysis of identified articles. Results. This review of concept-or argument-based articles and case analyses shows that there are five broad types of challenges-communication related, confidentiality related, professional-duty related, value-differences related and treatment-plan related; and four broad strategies-consultation, negotiating differences, using professional/prudential judgement and striving towards resolution-for managing these ethical challenges, in 21 fields of practice within the clinical context. Conclusion. This study greatly complements efforts aimed at providing a comprehensive overview of how health professionals manage information and related ethical challenges within the clinical context. Specifically, this study has identified four broad suggested strategies which may be employed to address the different challenges that can act as obstacles to communication within the clinical context. Further research is, however, needed to study whether these suggested strategies would indeed enhance communication and fiduciary relations between health professionals and patients.