BACKGROUND: Childhood cancers affect about 350 children every year in Sweden and are life-threatening diseases. During the treatment period, situations arise that can become morally challenging for the child. When knowing children\'s values and morally challenging situations in childhood cancer care, targeted ethics support could be developed and used in care.
OBJECTIVE: To explore children\'s values and moral dilemmas ​​when undergoing cancer treatment.
METHODS: This is a qualitative study based on empirical data. The data collection was conducted through three focus group interviews and six individual interviews with children between 10 and 18 years (n = 16). A content analysis methodology was used to generate themes. Children who were/have been treated for cancer at three childhood cancer centres in Sweden were invited to participate. The study was approved by the Swedish Ethical Review Authority. The children\'s participation was based on voluntariness and consent/assent.
RESULTS: During the analysis, five themes of values emerged: Personal relationships, Bodily ease and identity, Feeling in control and being involved, Positive distractions and Right care that is needed. Their moral dilemmas were thematized into: Should I consider others or not? Should I rest or not? and Should I refuse treatment or not?
CONCLUSIONS: Children undergoing cancer treatment want to have personal relationships with healthcare professionals. Their moral dilemmas were about questioning their own physical and psychological well-being against their expectations, the values of others and the treatment required. Further research is needed to understand how to deal with moral dilemmas in children undergoing cancer treatment.

BACKGROUND: The COVID-19 pandemic introduced new challenges to provide care and educate junior doctors (resident physicians). We sought to understand the positive and negative experiences of first-year resident physicians and describe potential ethical issues from their stories.
METHODS: We used narrative inquiry (NI) methodology and applied a semistructured interview guide with questions pertaining to ethical principles and both positive and negative aspects of the pandemic. Sampling was purposive. Interviews were audio recorded and transcribed. Three members of the research team coded transcripts in duplicate to elicit themes. Discrepancies were resolved through discussion to attain consensus. A composite story with threads was constructed.
RESULTS: 11 residents participated across several programmes. Three main themes emerged from the participants\' stories: (1) complexities in navigating intersecting healthcare and medical education systems, (2) balancing public health and the public good versus the individual and (3) fair health systems planning/healthcare delivery. Within these themes, participants\' journeys through the first wave were elicited through the threads of (1) engage us, (2) because we see the need for the duty to treat and (3) we are all in this together.
CONCLUSIONS: Cases of the ethical issues that took place during the COVID-19 pandemic may serve as a foundation on which ethics teaching and future pandemic planning can take place. Principles of clinical ethics and their limitations, when applied to public health issues, could help in contrasting clinical ethics with public health ethics.
CONCLUSIONS: Efforts to understand how resident physicians can navigate public health emergencies along with the ethical issues that arise could benefit both residency education and healthcare systems.

UNASSIGNED: Health agency refers to one\'s capacity to form health-related goals, experience control, and possess the means to pursue them. Low socioeconomic status (SES) is linked to impaired health agency and increased risk of adverse pregnancy outcomes, potentially due to a reduced tendency to seek care. Better healthcare availability may not improve their pregnancy outcomes, and therefore improved understanding of maternal health agency is paramount.
UNASSIGNED: Semi-structured interviews were conducted with 15 participants who either had children or desired to have them. Low SES was determined by neighborhood median income and educational attainment. A thematic content analyses was conducted.
UNASSIGNED: Two themes emerged: 1) Origin and development of personal goals, and 2) Awareness and competence. Participant\'s goals stemmed from cultural norms, personal narratives, and intuition. Integrated goals were those participants valued highly, were aware of, and strived for. Four subthemes were identified in goal-awareness and competence. Internal conflict due to discrepancies between goals and behavior resulted in the need to balance the burdens and benefits of behavior change.
UNASSIGNED: Maternal health agency is a modifiable outcome dependent on goal-awareness and various factors. Impaired agency seemed to stem from lack of goal-awareness rather than an inability to meet established pillars.

Background: Uterus transplantation (UTx) provides women with absolute uterine-factor infertility (AUFI) the opportunity to carry their own pregnancy and deliver a child. There are multiple ethical and medical concerns associated with UTx. Since the last survey of US provider perceptions of UTx in 2018, there have been additional reports of successful transplantations and pregnancies. This study aimed to identify the perception of UTx among providers involved in the diagnosis of AUFI and on the transplant team to help us understand knowledge gaps and determine what barriers must be overcome for UTx to be used in general clinical practice. Methods: We administered REDCap surveys to conference attendees at the 2023 American College of Obstetricians and Gynecologists (ACOG) conference and 2023 American Transplant Congress (ATC). Participants were recruited by medical student volunteers. Results: Two hundred ACOG and ATC attendees completed the survey. Medical concerns related to UTx were reported by 42% of providers from ACOG compared to 22% of providers from ATC. Overall, 76% of participants agreed that UTx should be an option for patients with congenital AUFI. Lastly, 68% of participants agreed that the procedure should be presented as an option for transgender women. Conclusions: This study further elucidates the perception of UTx among obstetricians/gynecologists and transplant physicians. We found greater support for the procedure than in previous studies. This study also demonstrates provider support for presenting this procedure as an option for transgender women.

BACKGROUND: Recognizing patients\' rights as fundamental human rights, the global healthcare community, including the World Health Organization and various nursing organizations, has emphasized the critical role of nurses in upholding these rights through ethical practice and patient-centered care. However, in the complex landscape of healthcare, nurses in Vietnam face various ethical issues and challenges that may impede their ability to protect patient rights effectively, necessitating tools for better ethical decision-making and practice.
OBJECTIVE: This study aims to translate the Nurses\' Ethical Behaviours for Protecting Patient Rights Scale (NEBPPR) into Vietnamese and evaluate the validity and reliability of the V-NEBPPRS.
METHODS: The original scale underwent a cross-cultural translation process to be adapted into Vietnamese. Construct validity was assessed using confirmatory factor analysis (CFA). The convergent validity, discriminant validity, and reliability of the V-NEBPPRS were evaluated.
RESULTS: After removing four items with factor loading below 0.5, the V-NEBPPRS comprises 24 items divided into five factors. CFA demonstrated a good model fit (χ2/df = 2.86; GFI = 0.87; IFI = 0.85; CFI = 0.84; RMSEA = 0.07). Convergent and discriminant validity were confirmed with extracted mean variance ranging from 0.54 to 0.67, 0.54 to 0.67, and composite reliability from 0.73 to 0.81. Cronbach\'s α coefficient was 0.85 for the total scale and ranged from 0.70 to 0.79 for five subscales.
CONCLUSIONS: The V-NEBPPRS is a reliable tool, providing nursing leaders and researchers with the means to utilize the V-NEBPPRS for assessing and promoting nurses\' awareness and behaviour in safeguarding patients\' rights, thereby contributing to improved overall health outcomes.

BACKGROUND: Innovative tools leveraging artificial intelligence (AI) and machine learning (ML) are rapidly being developed for medicine, with new applications emerging in prediction, diagnosis, and treatment across a range of illnesses, patient populations, and clinical procedures. One barrier for successful innovation is the scarcity of research in the current literature seeking and analyzing the views of AI or ML researchers and physicians to support ethical guidance.
OBJECTIVE: This study aims to describe, using a qualitative approach, the landscape of ethical issues that AI or ML researchers and physicians with professional exposure to AI or ML tools observe or anticipate in the development and use of AI and ML in medicine.
METHODS: Semistructured interviews were used to facilitate in-depth, open-ended discussion, and a purposeful sampling technique was used to identify and recruit participants. We conducted 21 semistructured interviews with a purposeful sample of AI and ML researchers (n=10) and physicians (n=11). We asked interviewees about their views regarding ethical considerations related to the adoption of AI and ML in medicine. Interviews were transcribed and deidentified by members of our research team. Data analysis was guided by the principles of qualitative content analysis. This approach, in which transcribed data is broken down into descriptive units that are named and sorted based on their content, allows for the inductive emergence of codes directly from the data set.
RESULTS: Notably, both researchers and physicians articulated concerns regarding how AI and ML innovations are shaped in their early development (ie, the problem formulation stage). Considerations encompassed the assessment of research priorities and motivations, clarity and centeredness of clinical needs, professional and demographic diversity of research teams, and interdisciplinary knowledge generation and collaboration. Phase-1 ethical issues identified by interviewees were notably interdisciplinary in nature and invited questions regarding how to align priorities and values across disciplines and ensure clinical value throughout the development and implementation of medical AI and ML. Relatedly, interviewees suggested interdisciplinary solutions to these issues, for example, more resources to support knowledge generation and collaboration between developers and physicians, engagement with a broader range of stakeholders, and efforts to increase diversity in research broadly and within individual teams.
CONCLUSIONS: These qualitative findings help elucidate several ethical challenges anticipated or encountered in AI and ML for health care. Our study is unique in that its use of open-ended questions allowed interviewees to explore their sentiments and perspectives without overreliance on implicit assumptions about what AI and ML currently are or are not. This analysis, however, does not include the perspectives of other relevant stakeholder groups, such as patients, ethicists, industry researchers or representatives, or other health care professionals beyond physicians. Additional qualitative and quantitative research is needed to reproduce and build on these findings.

OBJECTIVE: This paper explores how healthcare administration students perceive the integration of Artificial Intelligence (AI) in healthcare leadership, mainly focusing on the sustainability aspects involved. It aims to identify gaps in current educational curricula and suggests enhancements to better prepare future healthcare professionals for the evolving demands of AI-driven healthcare environments.
METHODS: This study utilized a cross-sectional survey design to understand healthcare administration students\' perceptions regarding integrating AI in healthcare leadership. An online questionnaire, developed from an extensive literature review covering fundamental AI knowledge and its role in sustainable leadership, was distributed to students majoring and minoring in healthcare administration. This methodological approach garnered participation from 62 students, providing insights and perspectives crucial for the study\'s objectives.
RESULTS: The research revealed that while a significant majority of healthcare administration students (70%) recognize the potential of AI in fostering sustainable leadership in healthcare, only 30% feel adequately prepared to work in AI-integrated environments. Additionally, students were interested in learning more about AI applications in healthcare and the role of AI in sustainable leadership, underscoring the need for comprehensive AI-focused education in their curriculum.
CONCLUSIONS: The research is limited by its focus on a single academic institution, which may not fully represent the diversity of perspectives in healthcare administration.
CONCLUSIONS: This study highlights the need for healthcare administration curricula to incorporate AI education, aligning theoretical knowledge with practical applications, to effectively prepare future professionals for the evolving demands of AI-integrated healthcare environments.
CONCLUSIONS: This research paper presents insights into healthcare administration students\' readiness and perspectives toward AI integration in healthcare leadership, filling a critical gap in understanding the educational needs in the evolving landscape of AI-driven healthcare.

BACKGROUND: Ensuring morally competent nurses depends on many factors, such as environmental, social, political, and cultural. However, several inadequacies in nursing education have been documented, and no common framework has been established for how nursing ethics should be taught in undergraduate education.
OBJECTIVE: What are the different approaches across nursing programmes established in teaching ethics? What are the main similarities and differences across programmes facilitating a common understanding in developing a curriculum capable of preparing a morally competent nurse?
METHODS: International comparative education study in five steps: (1) formulating the initial question; (2) defining the units of comparison; (3) determining the variables of comparison; (4) describing the findings; (5) interpreting the findings. The comparative variables were identified, extracted, and populated in a piloted grid.
METHODS: Six universities were purposefully selected by the Promoting a Morally Competent Nurse project partners for their nursing education curricula as delivered in 2022-2023.
METHODS: No ethical approval was required, given no human participants and public data regarding nursing curricula.
RESULTS: Variability emerged in the terminologies used in naming the courses, the numbers of credits and hours devoted to teaching ethics, when the courses are delivered (since the initial semesters of nursing education or concentrated in the final years), and their main modes of delivery (a single or separate module or integrated across the curriculum). Contents have some similarities, whereas the teaching methods varied and included (or not) explicit connections with clinical practice. Attendance is mandatory in all courses. The assessment methods used varied from knowledge-based to more competence-based approaches involving multidimensional strategies.
CONCLUSIONS: This comparative study explored similarities and differences across nursing programmes in six different European countries. The reviewed ethics curricula lack significant clarity, and they offer important areas to consider for future development. Issues emerged regarding terminologies, learning workloads, when to deliver, how to deliver, the main contents, and the teaching and assessment methods that merit further discussion.

BACKGROUND: Diagnostic uncertainty is common, but its communication to patients is under-explored. This study aimed to (1) characterise variation in doctors\' communication of diagnostic uncertainty and (2) explore why variation occurred.
METHODS: Four written vignettes of clinical scenarios involving diagnostic uncertainty were developed. Doctors were recruited from five hospitals until theoretical saturation was reached (n = 36). Participants read vignettes in a randomised order, and were asked to discuss the diagnosis/plan with an online interviewer, as they would with a \'typical patient\'. Semi-structured interviews explored reasons for communication choices. Interview transcripts were coded; quantitative and qualitative (thematic) analyses were undertaken.
RESULTS: There was marked variation in doctors\' communication: in their discussion about differential diagnoses, their reference to the level of uncertainty in diagnoses/investigations and their acknowledgement of diagnostic uncertainty when safety-netting. Implicit expressions of uncertainty were more common than explicit. Participants expressed both different communication goals (including reducing patient anxiety, building trust, empowering patients and protecting against diagnostic errors) and different perspectives on how to achieve these goals. Training in diagnostic uncertainty communication is rare, but many felt it would be useful.
CONCLUSIONS: Significant variation in diagnostic uncertainty communication exists, even in a controlled setting. Differing communication goals-often grounded in conflicting ethical principles, for example, respect for autonomy versus nonmaleficence-and differing ideas on how to prioritise and achieve them may underlie this. The variation in communication behaviours observed has important implications for patient safety and health inequalities. Patient-focused research is required to guide practice.
UNASSIGNED: In the design stage of the study, two patient and public involvement groups (consisting of members of the public of a range of ages and backgrounds) were consulted to gain an understanding of patient perspectives on the concept of communicating diagnostic uncertainty. Their feedback informed the formulations of the research questions and the choice of vignettes used.

In accordance with China\'s regulations on the prevention and control of HIV/AIDS, individuals diagnosed with HIV are required to disclose their medical condition when soliciting medical care in Mainland China. Empirical field investigations, however, indicate that people living with HIV (PLHIV) predominantly comply with this mandate only under conditions of absolute necessity. The ensuing conundrum, juxtaposing the imperative of privacy against the duty of disclosure, has materialised into a recurrent vicious cycle in its practical application, intensifying the intrinsic trust disparities characterising doctor-patient interactions. A meticulous scrutiny of pertinent legal precedents, coupled with in-depth field studies, reveals that the genesis of these complications can be traced back to an unforeseen metamorphosis in the legislative intent underpinning HIV/AIDS prevention and therapeutic strategies. While the initial objective was risk mitigation, the effect of enactment in real-world scenarios has significantly decreased. Owing to factors including extensive media reporting as well as prevailing public discourse, PLHIV, rather than being perceived as rights-bearing entities in legal frameworks, are increasingly relegated to the restrictive and dehumanising labels of \'HIV/AIDS\'. As these individuals navigate their rights through alternative non-regulatory channels, circumventing formal legal obligations, their efficacy in actualising these rights is concurrently undermined.