An Ethical Framework for Allocating Scarce Life-Saving Chemotherapy and Supportive Care Drugs for Childhood Cancer
| Autor: | Conrad V. Fernandez, Steven Joffe, Brooke Bernhardt, Catherine Woodman, Kim Pyke-Grimm, Stacey L. Berg, Yoram Unguru |
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| Rok vydání: | 2016 |
| Předmět: |
Cancer Research
Evidence-based practice Process (engineering) Compromise media_common.quotation_subject Clinical Decision-Making MEDLINE Antineoplastic Agents Outcome (game theory) Health care rationing 03 medical and health sciences 0302 clinical medicine Multidisciplinary approach Neoplasms Humans Medicine Family 030212 general & internal medicine Child media_common Health Care Rationing United States Food and Drug Administration business.industry Rationing United States Oncology Risk analysis (engineering) 030220 oncology & carcinogenesis Practice Guidelines as Topic Interdisciplinary Communication Drugs Essential business |
| Zdroj: | JNCI: Journal of the National Cancer Institute. 108 |
| ISSN: | 1460-2105 0027-8874 |
| DOI: | 10.1093/jnci/djv392 |
| Popis: | Shortages of life-saving chemotherapy and supportive care agents for children with cancer are frequent. These shortages directly affect patients' lives, compromise both standard of care therapies and clinical research, and create substantial ethical challenges. Efforts to prevent drug shortages have yet to gain traction, and existing prioritization frameworks lack concrete guidance clinicians need when faced with difficult prioritization decisions among equally deserving children with cancer. The ethical framework proposed in this Commentary is based upon multidisciplinary expert opinion, further strengthened by an independent panel of peer consultants. The two-step allocation process includes strategies to mitigate existing shortages by minimizing waste and addresses actual prioritization across and within diseases according to a modified utilitarian model that maximizes total benefit while respecting limited constraints on differential treatment of individuals. The framework provides reasoning for explicit decision-making in the face of an actual drug shortage. Moreover, it minimizes bias that might occur when individual clinicians or institutions are forced to make bedside rationing and prioritization decisions and addresses the challenge that individual clinicians face when confronted with bedside decisions regarding allocation. Whenever possible, allocation decisions should be supported by evidence-based recommendations. "Curability," prognosis, and the incremental importance of a particular drug to a given patient's outcome are the critical factors to consider when deciding how to allocate scarce life-saving cancer drugs. |
| Databáze: | OpenAIRE |
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