J Fraser1, C Alexander. 1. School of Health, University of New England, Armidale, NSW 2351, Australia. john.fraser@hnehealth.nsw.gov.au
Abstract
BACKGROUND: Health researchers must weigh the benefits and risks of publishing their findings. OBJECTIVE: To explore differences in decision making between rural health researchers and managers on the publication of research from small identifiable populations. METHOD: A survey that investigated the attitudes of Australian rural general practitioners (GPs) to nurse practitioners was explored. Decisions on the study's publication were analysed with bioethical principles and health service management ethical decision-making models. RESULTS: Response rate was 78.5% (62/79 GPs). 84-94% of GP responders considered it to be undesirable for nurse practitioners to initiate referrals to medical specialists (n=58), to initiate diagnostic imaging (n=56) and to prescribe medication (n=52). BIOETHICAL ANALYSIS: It was concluded that the principle of beneficence outweighed the principle of non-maleficence and that a valid justification for the publication of these results existed. DECISION-MAKING MODELS OF HEALTH SERVICE MANAGERS: On the basis of models of ethical decision making in health service management, the decisions of the area's health managers resulted in approval to publish this project's results being denied. This was because the perceived risks to the health service outweighed benefits. Confidentiality could not be ensured by publication under a regional nom de plume. CONCLUSIONS: A conflict of interests between rural researchers and health managers on publication of results is shown by this case study. Researchers and managers at times owe competing duties to key stakeholders. Both weigh the estimated risks and benefits of the effect of research findings. This is particularly true in a rural area, where identification of the subjects becomes more likely.
BACKGROUND: Health researchers must weigh the benefits and risks of publishing their findings. OBJECTIVE: To explore differences in decision making between rural health researchers and managers on the publication of research from small identifiable populations. METHOD: A survey that investigated the attitudes of Australian rural general practitioners (GPs) to nurse practitioners was explored. Decisions on the study's publication were analysed with bioethical principles and health service management ethical decision-making models. RESULTS: Response rate was 78.5% (62/79 GPs). 84-94% of GP responders considered it to be undesirable for nurse practitioners to initiate referrals to medical specialists (n=58), to initiate diagnostic imaging (n=56) and to prescribe medication (n=52). BIOETHICAL ANALYSIS: It was concluded that the principle of beneficence outweighed the principle of non-maleficence and that a valid justification for the publication of these results existed. DECISION-MAKING MODELS OF HEALTH SERVICE MANAGERS: On the basis of models of ethical decision making in health service management, the decisions of the area's health managers resulted in approval to publish this project's results being denied. This was because the perceived risks to the health service outweighed benefits. Confidentiality could not be ensured by publication under a regional nom de plume. CONCLUSIONS: A conflict of interests between rural researchers and health managers on publication of results is shown by this case study. Researchers and managers at times owe competing duties to key stakeholders. Both weigh the estimated risks and benefits of the effect of research findings. This is particularly true in a rural area, where identification of the subjects becomes more likely.
Authors: Jacqueline E Parsons; Tracy L Merlin; Judy E Taylor; David Wilkinson; Janet E Hiller Journal: Aust J Rural Health Date: 2003-10 Impact factor: 1.662