What is a good health check? An interview study of health check providers’ views and practices

BMC Medical Ethics

Research Article

Maartje H. N. Schermer¹  Eva C. A. Asscher¹  Yrrah H. Stol¹ 

[1] Department of Medical Ethics and Philosophy, ErasmusMC, Na building, room Na 21.197 Postbus, 2040 3000, Rotterdam, CA, The Netherlands;

关键词: Health check;    Screening;    Ethics;    Criteria;    Interviews;    Qualitative research;    Informed consent;   

DOI  :  10.1186/s12910-017-0213-x

 received in 2017-03-30, accepted in 2017-09-15,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundHealth checks identify (risk factors for) disease in people without symptoms. They may be offered by the government through population screenings and by other providers to individual users as ‘personal health checks’. Health check providers’ perspective of ‘good’ health checks may further the debate on the ethical evaluation and possible regulation of these personal health checks.MethodsIn 2015, we interviewed twenty Dutch health check providers on criteria for ‘good’ health checks, and the role these criteria play in their practices.ResultsProviders unanimously formulate a number of minimal criteria: Checks must focus on (risk factors for) treatable/preventable disease; Tests must be reliable and clinically valid; Participation must be informed and voluntary; Checks should provide more benefits than harms; Governmental screenings should be cost-effective. Aspirational criteria mentioned were: Follow-up care should be provided; Providers should be skilled and experienced professionals that put the benefit of (potential) users first; Providers should take time and attention. Some criteria were contested: People should be free to test on any (risk factor for) disease; Health checks should only be performed in people at high risk for disease that are likely to implement health advice; Follow up care of privately funded tests should not drain on collective resources.Providers do not always fulfil their own criteria. Their reasons reveal conflicts between criteria, conflicts between criteria and other ethical values, and point to components in the (Dutch) organisation of health care that hinder an ethical provision of health checks. Moreover, providers consider informed consent a criterion that is hard to establish in practice.ConclusionsAccording to providers, personal health checks should meet the same criteria as population screenings, with the exception of cost-effectiveness. Providers do not always fulfil their own criteria. Results indicate that in thinking about the ethics of health checks potential conflicts between criteria and underlying values should be explicated, guidance in weighing of criteria should be provided and the larger context should be taken into account: other actors than providers need to take up responsibility, and ideally benefits and harms of health checks should be weighed against other measures targeting (risk factors for) disease.

【 授权许可】

CC BY   
© The Author(s). 2017