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Iskander 2020

Page history last edited by reem.elsherif@mail.mcgill.ca 1 year, 7 months ago

Iskander, Renata (2020). Ethical Management of Incidental Findings in Emergency Care Settings. McGill Family Medicine Studies Online, 15:e05


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Incidental findings are findings discovered during medical testing, such as unexpected imaging results from an x-ray, and are unrelated to the primary purpose for which a test was sought. Some incidental findings have implications for patient autonomy and welfare. Incidental findings can involve risks as well as potential benefits. Incidental findings found in emergency departments are difficult to manage because of the fast-paced and crowded environment, as well as limitations to physician-patient relationships. This thesis explores policy and guideline documents, as well as literature, on the legal, professional, and ethical duties of emergency department healthcare professionals in identifying, disclosing, and managing incidental findings. A background of incidental findings and the importance of exploring it within the emergency department setting is presented, as well as an explanation of the objective and research methods. A critical interpretive literature review was conducted to explore the current understanding and state of incidental findings in emergency departments. Following screening, 98 studies were included, where 78 studies reported empirical data. Most of the 78 studies (87%) presented the frequency of incidental findings, with approximately one-quarter reporting the prevalence to be below 10% and the highest reported being 97%, with an average of 34%. Only 29% explored incidental finding reporting rates in documentation. Most (83%) did not report patient disclosure or follow-up rates, but when reported, notification rates were as low as 0.2%, with an average of 18%. The literature revealed recommendations for effective management, including implementation of automatic feedback or alert mechanisms, clarification of responsibilities within treating teams, and improvements to patient documentation. Following the literature review is a thematic content analysis of codes of ethics, health profession guidelines, research-context guidance, and legislation and government documents (n=31). The themes represent duties and expectations of healthcare professionals for incidental finding management and include: autonomy and informed consent, beneficence and non-maleficence, veracity, justice, standard of care, continuity of care, and guidance development. After exploring the literature and policies and guidance, an ethical analysis identifies the moral challenges distinct to emergency department settings that impede incidental finding management. These challenges include time constraints, determining capacity to consent, and limited physician-patient relationships. Discussions on the transferability of primary care and research-context guidance revealed that emergency settings require context-specific guidance, but can borrow select guidance from other settings. Considerations for autonomy, veracity, and justice, as well as decision-making models can help inform ethical responsibilities on incidental findings. This work explores the gaps in knowledge, research, and professional policy and guidance on incidental findings and can thus help advance discussions and guidance to elucidate ethical management of incidental findings



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