Exploration medizinethischer Implikationen individualisierter Medizin beim lokal fortgeschrittenen Rektumkarzinom aus Sicht von Ärzten und Forschern - eine empirisch-ethische Untersuchung

Exploration medizinethischer Implikationen individualisierter Medizin beim lokal fortgeschrittenen Rektumkarzinom aus Sicht von Ärzten und Forschern - eine empirisch-ethische Untersuchung

Exploration of physicians’ and researchers’ understanding of the implications of individualized prognostics and diagnostics of the locally advanced colorectal cancer on medical ethics. An ethical-empirical study

Arndt Christian Heßling

Doctoral thesis

Date of Examination: 2014-07-07

Date of issue: 2014-06-30

Advisor: Schicktanz, Silke Prof. Dr.

Referee: Ghadimi, Michael Prof. Dr.

Referee: Oppermann, Martin Prof. Dr.

Referee: Müller-Dornieden, Annegret Prof. Dr.

Referee: Mausberg, Rainer Prof. Dr.

Persistent Address: http://hdl.handle.net/11858/00-1735-0000-0022-5F03-1

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Abstract

English

So-called individualized medicine is an emerging concept in clinical research and clinical practice. We conducted a social-empirical interview study with members of a leading German clinical research group (KFO 179) about the use of individualized medicine in local advanced colorectal cancer. The aim of the study was to explore professional assessments and personal opinions regarding the social and moral conflicts associated with the diagnostic use of a “Rectum chip”, whose result might dictate future decisions about whether patients with local advanced colorectal cancer receive neoadjuvant CT / RT or not. Right now, there is little insight about how experts judge such concerns. The interviews with physicians and researchers (n=19) were based on a theme-centered interview guide. The material of the interview was analyzed using qualitative content analysis. The principles of biomedical ethics by Beauchamp and Childress served as guidance within the analysis and the discussion. The following six points became apparent: (1) dissatisfaction with the results of the current standard therapy, (2) different demands about the reliability of the Rektumchip, (3) different strategies about how to deal with uncertainty and probabilities regarding diagnostic and genetic tests as well as related patient education, (4) the possible positive and negative effects of a Rektumchip on patient’s autonomy as well as (5) the doctor-patient relationship and (6) the importance of data privacy for genetic information that will be increasingly collected for research and application in individualized medicine. Overall, our empirical study was very useful for collecting assessments by experts in the field of individualized medicine concerning possible related ethical conflicts. It can be assumed that these study results can be used to compare the perspective of professionals with those of patients with regards to individualized medicine. A comparison of the interests and problems of all parties affected by the use of individualized medicine may help to identify typical misconceptions and to counteract exaggerated expectations effectively.

Keywords: individualized medicine; empirical-ethics research; oncology research; informed consent; personalized medicine