ArticleBMC medical ethics2025
A multidimensional model of ethical challenges in hemodialysis: a qualitative study for specialist physicians.
Article in BMC medical ethics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- A multi-systemic ethical dilemma model in hemodialysis patients: a qualitative study.BMC medical ethics · 2026Article
- A multi-tiered model of ethical challenges in nursing practice: a qualitative phenomenological study.BMC nursing · 2026Article
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Abstract
backgroundChronic Kidney Disease affects 13% of China's population, with hemodialysis consuming 1-3% of national healthcare expenditure. Hemodialysis patients face complex physical-psychological burdens, while physicians in Traditional Chinese Medicine (TCM) hospitals navigate unique ethical dilemmas arising from dual Western-TCM practice paradigms, cultural expectations, and systemic healthcare pressures. This study employed Social-Ecological Systems Theory to analyze these multilayered challenges and developed a structured ethical model.
methodsThis study followed a qualitative phenomenological research design. Maximum variation purposive sampling was employed to recruit 28 hemodialysis physicians from six TCM hospitals across five cities in Shandong Province, China. Data were collected through focus group and in-depth individual interviews with 28 hemodialysis physicians from November 2024 to January 2025, and were analyzed following Colaizzi's descriptive analysis framework. The framework of the Society Ecosystems Theory was applied to analyze how multilevel systemic interactions shape ethical challenges, thereby constructing a multidimensional conceptual model.
resultsEthical challenges encountered by hemodialysis physicians were categorized into three themes with seven subthemes and 17 subcategories. Based on these findings, a three-tiered model was developed: macro-system challenges involving policy, organizational, and cultural dimensions; meso-system challenges emerging from interprofessional dynamics, particularly doctor-doctor, doctor-nurse, and doctor-patient relationships; and micro-system challenges pertaining to individual difficulties.
conclusionThe conceptual model reveals the multi-level nature of ethical challenges in hemodialysis practice, spanning systemic policies, interprofessional relationships, and individual dilemmas. The findings specifically call for targeted interventions at each level: policy reforms to address resource constraints, team-based strategies to improve clinical collaborations, and support systems to alleviate practitioners' ethical distress. These evidence-based insights empower stakeholders to develop comprehensive solutions addressing the interconnected challenges identified.
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