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Research ArticleEthics Feature

Moral Distress with Obstacles to Hepatitis C Treatment: A Council of Academic Family Medicine Educational Research Alliance (CERA) Study of Family Medicine Program Directors

Aditya Simha, Camille M. Webb, Ramakrishna Prasad, N. Randall Kolb and Peter J. Veldkamp
The Journal of the American Board of Family Medicine March 2018, 31 (2) 286-291; DOI: https://doi.org/10.3122/jabfm.2018.02.170220
Aditya Simha
From the Department of Management, University of Wisconsin–Whitewater, Whitewater, WI (AS); Internal Medicine Residency Program, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA (CMW); Department of Family Medicine, University of Pittsburgh (RP); UPMC Shadyside Family Medicine Residency Program, Pittsburgh (NRK); Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh (PJV).
PhD
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Camille M. Webb
From the Department of Management, University of Wisconsin–Whitewater, Whitewater, WI (AS); Internal Medicine Residency Program, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA (CMW); Department of Family Medicine, University of Pittsburgh (RP); UPMC Shadyside Family Medicine Residency Program, Pittsburgh (NRK); Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh (PJV).
MD
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Ramakrishna Prasad
From the Department of Management, University of Wisconsin–Whitewater, Whitewater, WI (AS); Internal Medicine Residency Program, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA (CMW); Department of Family Medicine, University of Pittsburgh (RP); UPMC Shadyside Family Medicine Residency Program, Pittsburgh (NRK); Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh (PJV).
MD, MPH
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N. Randall Kolb
From the Department of Management, University of Wisconsin–Whitewater, Whitewater, WI (AS); Internal Medicine Residency Program, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA (CMW); Department of Family Medicine, University of Pittsburgh (RP); UPMC Shadyside Family Medicine Residency Program, Pittsburgh (NRK); Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh (PJV).
MD
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Peter J. Veldkamp
From the Department of Management, University of Wisconsin–Whitewater, Whitewater, WI (AS); Internal Medicine Residency Program, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA (CMW); Department of Family Medicine, University of Pittsburgh (RP); UPMC Shadyside Family Medicine Residency Program, Pittsburgh (NRK); Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh (PJV).
MD, MSc
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Abstract

Background and Objective: To determine whether family medicine program directors (PDs) experienced moral distress due to obstacles to Hepatitis C virus (HCV) treatment, and to explore whether they found those obstacles to be unethical.

Design: An omnibus survey by the Council of Academic Family Medicine's Educational Research Alliance was administered to 452 and completed by 273 US-based PDs. The survey gauged attitudes and opinions regarding ethical dilemmas in patient access to HCV treatment.

Results: Most of the respondents were male. Sixty-four percent of respondents believed that treatment should be an option for all patients regardless of cost. Forty-one percent believed that it was unethical to deny treatment based on past or current substance use, and 38% believed treatment should be offered to patients who were substance abusers. Moral distress was reported by 61% (score >3) of participants when they were unable to offer treatment to patients due to the patient's failure to meet eligibility criteria. In addition, PDs reporting moderate-to-high levels of moral distress were also likely to report the following opinions: 1) treatment should be offered regardless of cost, 2) it is unethical to deny treatment based on past behavior, 3) substance abusers should be offered treatment, 4) it is unethical for medicine to be prohibitively expensive, and 5) Medicaid policy that limits treatment will worsen racial and ethnic disparities.

Conclusions: Currently, important ethical dilemmas exist in the access and delivery of HCV therapy. Although a diversity of opinions is noted, a significant proportion of PDs are concerned about patients' inability to avail equitable care and experience distress. In some cases, this moral distress is in response to, and in conflict with, current guidelines.

  • Hepatitis C
  • Hepacivirus
  • Medical Ethics
  • Surveys and Questionnaires
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The Journal of the American Board of Family     Medicine: 31 (2)
The Journal of the American Board of Family Medicine
Vol. 31, Issue 2
March-April 2018
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Moral Distress with Obstacles to Hepatitis C Treatment: A Council of Academic Family Medicine Educational Research Alliance (CERA) Study of Family Medicine Program Directors
Aditya Simha, Camille M. Webb, Ramakrishna Prasad, N. Randall Kolb, Peter J. Veldkamp
The Journal of the American Board of Family Medicine Mar 2018, 31 (2) 286-291; DOI: 10.3122/jabfm.2018.02.170220

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Moral Distress with Obstacles to Hepatitis C Treatment: A Council of Academic Family Medicine Educational Research Alliance (CERA) Study of Family Medicine Program Directors
Aditya Simha, Camille M. Webb, Ramakrishna Prasad, N. Randall Kolb, Peter J. Veldkamp
The Journal of the American Board of Family Medicine Mar 2018, 31 (2) 286-291; DOI: 10.3122/jabfm.2018.02.170220
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