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Advisor(s)
Abstract(s)
Introdução: A medicina de precisão, também conhecida como medicina personalizada é
uma área em constante evolução que tem impactado positivamente a abordagem dos
doentes nas mais diversas áreas da medicina, incluindo a oncologia. Ao integrar as
caraterísticas individuais de cada doente, incluindo fatores genéticos, ambientais e de
estilo de vida, a medicina de precisão permite melhorar a rapidez e eficácia, não só dos
diagnósticos, mas também dos tratamentos. Esta abordagem holística do doente contribui
para a humanização da medicina, tendo o potencial de aumentar os outcomes em saúde.
De referir, ainda, o crescente papel da medicina de precisão no que diz respeito à área da
prevenção. No entanto, com o desenvolvimento da medicina de precisão várias questões
éticas se levantam, nomeadamente, ao nível da privacidade e confidencialidade dos dados
genéticos dos doentes, do consentimento informado, da autonomia e da equidade no
acesso a esta prática.
Objetivo: Abordar os desafios éticos da medicina de precisão na área da oncologia.
Metodologia: Foi realizada uma revisão sistemática com pesquisa nas bases de dados
PubMed e Science Direct de modo a encontrar artigos que respondessem à pergunta
investigadora. Esta pesquisa abrangeu todos os artigos publicados entre 2013 e 2023.
Todos os títulos e abstracts encontrados foram sistematicamente avaliados. Nesta
pesquisa foram incluídos artigos com dados originais escritos em inglês, português e
espanhol. Para a seleção dos estudos recorreu-se ao diagrama PRISMA. Os estudos
considerados pertinentes foram lidos na íntegra e, posteriormente, confrontados com os
critérios de inclusão e exclusão. Para cada estudo foi realizada uma tabela para extração de
dados. Foram utilizados os critérios de Hawker et al para avaliar a qualidade dos estudos
incluídos. Procedeu-se, ainda, à submissão na base de registo de protocolos e revisões
sistemáticas PROSPERO (CRD42023477191).
Resultados: O total de 18 estudos foram incluídos nesta revisão sistemática, tendo em
conta o cumprimento dos critérios de inclusão definidos. Existe heterogeneidade quanto às
datas de publicação dos estudos, bem como à origem qualitativa dos mesmos. A maioria
dos artigos provém da América (n=11), mais propriamente da América do Norte (n=10)
perfazendo mais de 50% dos estudos incluídos nesta revisão sistemática. O princípio da
autonomia é o mais abordado (94,4%), seguido do consentimento informado (88,9%) e da privacidade (88,9%), justiça (77,8%), beneficência (61,1%), confidencialidade (38,9%),
segurança (11,1%) e, por último, da equidade (5,6%) e não maleficência (5,6%). Os
outcomes foram consensuais entre a maioria dos estudos analisados.
Conclusão: Os resultados presentes nesta revisão sistemática foram obtidos através de
uma adequada estratégia de pesquisa, seleção de artigos e extração de dados. Foi
verificada existência de heterogeneidade ao nível dos desafios éticos encontrados, sendo a
autonomia o princípio bioético mais abordado, seguindo-se a temática do consentimento
informado e privacidade, justiça, beneficência, confidencialidade, segurança, equidade e
não maleficência, respetivamente. A crescente preocupação com a autonomia reflete a
importância de respeitar a capacidade de escolha dos pacientes no que concerne à
medicina de precisão, destacando a imprescindibilidade de uma comunicação
transparente e eficaz. A relevância atribuída ao consentimento informado e à privacidade
traduz a crucialidade de garantir a proteção dos dados genéticos.
Foi, igualmente, possível verificar que com vista a alcançar um julgamento ou ação moral
coerente, é necessário recorrer a uma sólida fundamentação teórica juntamente com um
profundo conhecimento sobre os princípios éticos, nomeadamente, a autonomia,
beneficência, não maleficência e justiça. Apesar dos avanços notáveis na medicina de
precisão, especialmente na oncologia, o futuro é incerto. O desafio crucial reside na
capacitação de profissionais de saúde especializados, aptos a esclarecer os pacientes e gerir
o progresso científico. Recomenda-se o aumento do conhecimento nesta área por meio de
estudos que abordem os numerosos desafios éticos identificados.
Introduction: Precision medicine, also known as personalised medicine, is an everevolving field that has significantly impacted the patient-centred approach across various medical domains, including oncology. By integrating individual patient characteristics such as genetic, environmental and lifestyle factors, precision medicine not only enhances the speed and effectiveness of diagnoses, but also improves treatment outcomes. This holist approach to patient care contributes to the humanization of medicine, holding the potential to improve health outcomes. It is noteworthy to highlight the increasing role of precision medicine in the realm of prevention. However, as precision medicine continues to evolve, several ethical considerations arise, particularly concerning the privacy and confidentiality of patients' genetic data, informed consent, autonomy, and equitable access to this practice. Aim: Addressing the ethical challenges of precision medicine in the field of oncology. Methods: A systematic review was conducted by searching the PubMed and Science Direct databases to identify articles addressing the research question. This inquiry encompassed all articles published between 2013 and 2023. All titles and abstracts retrieved underwent systematic evaluation. Articles with original data, written in English, Portuguese, and Spanish, were included in this search. The PRISMA diagram guided the selection of studies. Relevant studies were thoroughly read, subsequently juxtaposed with the inclusion and exclusion criteria. A data extraction table was created for each study. Hawker et al.'s criteria were employed to assess the quality of the included studies. Additionally, submission to the PROSPERO database for systematic reviews andprotocols was carried out. Results: A total of 18 studies were included in this systematic review, considering the fulfillment of the defined inclusion criteria. There is heterogeneity regarding the publication dates and qualitative origin of the studies. The majority of articles are from the Americas (n=11), specifically from North America (n=10), comprising over 50% of the studies included in this systematic review. The principle of autonomy is the most addressed (94.4%), followed by informed consent (88.9%) and privacy (88.9%), justice (77.8%), beneficence (61.1%), confidentiality (38.9%), safety (11.1%), and finally, equity (5.6%) and non-maleficence (5.6%). Outcomes were consistent among most of the analysed studies. Conclusion: The results of this systematic review were obtained through an appropriate search strategy, article selection and data extraction. There was heterogeneity in terms of the ethical challenges encountered, with autonomy being the most frequently addressed bioethical principle, followed by informed consent and privacy, justice, beneficence, confidentiality, safety, equity, and non-maleficence, respectively. The growing concern with autonomy reflects the importance of respecting patients' ability to choose when it comes to precision medicine, highlighting the indispensability of transparent and effective communication. The importance given to informed consent and privacy reflects the importance of guaranteeing the protection of genetic data. It was also possible to verify that, in order to reach a coherent moral judgment or action, it is necessary to use a solid theoretical foundation together with a deep knowledge of ethical principles, namely autonomy, beneficence, non-maleficence and justice. Despite the remarkable advances in precision medicine, especially in oncology, the future is uncertain. The crucial challenge lies in training specialized health professionals who are able to enlighten patients and manage scientific progress. It is recommended to increase knowledge in this area through studies that address the numerous ethical challenges identified.
Introduction: Precision medicine, also known as personalised medicine, is an everevolving field that has significantly impacted the patient-centred approach across various medical domains, including oncology. By integrating individual patient characteristics such as genetic, environmental and lifestyle factors, precision medicine not only enhances the speed and effectiveness of diagnoses, but also improves treatment outcomes. This holist approach to patient care contributes to the humanization of medicine, holding the potential to improve health outcomes. It is noteworthy to highlight the increasing role of precision medicine in the realm of prevention. However, as precision medicine continues to evolve, several ethical considerations arise, particularly concerning the privacy and confidentiality of patients' genetic data, informed consent, autonomy, and equitable access to this practice. Aim: Addressing the ethical challenges of precision medicine in the field of oncology. Methods: A systematic review was conducted by searching the PubMed and Science Direct databases to identify articles addressing the research question. This inquiry encompassed all articles published between 2013 and 2023. All titles and abstracts retrieved underwent systematic evaluation. Articles with original data, written in English, Portuguese, and Spanish, were included in this search. The PRISMA diagram guided the selection of studies. Relevant studies were thoroughly read, subsequently juxtaposed with the inclusion and exclusion criteria. A data extraction table was created for each study. Hawker et al.'s criteria were employed to assess the quality of the included studies. Additionally, submission to the PROSPERO database for systematic reviews andprotocols was carried out. Results: A total of 18 studies were included in this systematic review, considering the fulfillment of the defined inclusion criteria. There is heterogeneity regarding the publication dates and qualitative origin of the studies. The majority of articles are from the Americas (n=11), specifically from North America (n=10), comprising over 50% of the studies included in this systematic review. The principle of autonomy is the most addressed (94.4%), followed by informed consent (88.9%) and privacy (88.9%), justice (77.8%), beneficence (61.1%), confidentiality (38.9%), safety (11.1%), and finally, equity (5.6%) and non-maleficence (5.6%). Outcomes were consistent among most of the analysed studies. Conclusion: The results of this systematic review were obtained through an appropriate search strategy, article selection and data extraction. There was heterogeneity in terms of the ethical challenges encountered, with autonomy being the most frequently addressed bioethical principle, followed by informed consent and privacy, justice, beneficence, confidentiality, safety, equity, and non-maleficence, respectively. The growing concern with autonomy reflects the importance of respecting patients' ability to choose when it comes to precision medicine, highlighting the indispensability of transparent and effective communication. The importance given to informed consent and privacy reflects the importance of guaranteeing the protection of genetic data. It was also possible to verify that, in order to reach a coherent moral judgment or action, it is necessary to use a solid theoretical foundation together with a deep knowledge of ethical principles, namely autonomy, beneficence, non-maleficence and justice. Despite the remarkable advances in precision medicine, especially in oncology, the future is uncertain. The crucial challenge lies in training specialized health professionals who are able to enlighten patients and manage scientific progress. It is recommended to increase knowledge in this area through studies that address the numerous ethical challenges identified.
Description
Keywords
Ética Medicina de Precisão Oncologia