Ethical issues in researching wait times for seniors in New Brunswick emergency departments

¶ … Wait Times Facing Older Adults in Emergency Departments in New Brunswick

Investigating Wait Times facing Seniors in Emergency Departments in New Brunswick

In the contemporary research environment, scientific research has delivered substantial health and social benefits, nevertheless, it has some troubling ethical dilemma. Typically, collecting data from human subject to complete health and medical research has been the major challenges facing researchers globally. One of the major challenges in understanding factors responsible for the longer wait times of older adults with ambulatory care is that the research will involve collecting sensitive information of subject participants.

Literature Review

In Canada, the hospital emergence departments are the major components of Canadian healthcare safety. Many patients suffering from life-threatening, serious illness and injuries present themselves to emergency departments because of symptoms that cannot be managed at home or in a healthcare provider's office.(Grudzen, Stone, & Morrison, 2011). The arrival of patients to the emergency department represents a key decision by which health care providers attempt to provide a quality healthcare and treatment plan for patients. Since the emergency departments focus on admitting patients facing serious life-threatening and serious illness, the efficiency and speed by which physicians receive the patients is very critical to the patient's outcomes. (ACEP, 2012). Since there is no proactive and systematic care system to prevent the use of emergency departments by older adults, the consequence has been associated to an increase in wait times for patients seeking for the EDs service., which can affect the quality of - times in the emergency departments and quality of healthcare delivery for the older adults in New Brunswick, Canada, there is still a shortage of quality scholarly research papers that investigate "wait times of seniors with Ambulatory Care Sensitive Condition in emergency departments of New Brunswick." "

A major factor responsible for the gap is that the data collection procedure to complete the proposal is based on medical ethical research principle that may affect the privacy of participants. This study attempts to fill the gap by carrying out an integrative research paper focusing on ethical issues that might be encountered in completing the proposal.

Research Questions

What are the ethical issues affecting the investigation of the wait times of senior citizens with Ambulatory Care Sensitive Condition in Emergency departments of New Brunswick?

What are the implementation strategies that can be employed to address the problem of ethical issues affecting the research?

What are the effective implementation strategies to reduce the "wait times of seniors with Ambulatory Care Sensitive Condition in emergency departments of New Brunswick, Canada"?

Rationale for Study

The rationale for the study is to investigate the ethical issue that might be encountered when investigating the "wait times of seniors with Ambulatory Care sensitive condition in emergency departments of New Brunswick." "

Research Methodology

The proposal will use quantitative technique to collect data using the survey method. A major benefit quantitative research is that it is cost effective and will allow the proposal to collect data from large number of participants. The researcher will collect demographic data of the participants, and EDs' wait times experience of participants. The Appendix 2 reveals the questionnaire format used to collect data.

Benefits of Research

The proposal will uncover the ethical issues affecting the data collection technique in order to understand the wait times in the emergency departments. The research findings will assist in developing strategies to reduce the wait times of older adults in the emergency departments. Apart from applying the research findings in the New Brunswick, the findings can be beneficial to other provinces in Canada. (Government Accountability Office, 2009).

Ethical Challenges

Ethical challenges associated to the proposal is that the participants are required to release some of their private information to complete the research.

Identification of Potential Ethical Issues

Wade, (2007) argues that ethical issues associated to the collection of patient's data for the research purpose make many potential participants be reluctant in releasing their private personal health data because of the fear that the data are no more private and can be released to the public. It is essential to realize that patients' data can consist of health issues which may reveal their level of cardiovascular risks, their rates of emergency admissions, the rate of their hospitalizations, and other private health issues that are highly confidential. Leila, Julie, Katie, et al. 2014) define data confidentiality "as a way of limiting how data about oneself may be used by others." (p 965). Due to high level of privacy associated to the patients' data, it may be challenging to collect data to complete the research. For example, some patients may feel embarrassed if approached with the intention to collect data concerning their rates of visits to the emergency departments.

Muthuswamy, (2013) contributes to the argument by pointing out that clinical research may face an ethical dilemma from the time the researcher formulates the research hypothesis till the research is complete. Safety and confidentiality of information released to the researcher is one of the major concern to the participants.

However, "record linkage of existing individual health-related data is a time and cost efficient way to answer important epidemiologic research questions"(Kerri, Clough-Gorr, Adrian Spoerri, et al. 2015 p 9). In Canada, health related data are protected with a strict protection regulation because of the issue of data privacy, thus, collecting health related data from patients can be a great challenge to the researcher. (Miriam, 2014).

Kim, (2012) also points out that participants are likely to be vulnerable when issues regarding collecting their private health information come in. The author argues that many participants will be concerned about the confidentiality of the data released. Due to the degree of risks associated to a collection of sensitive data, an intervention of clinicians is very critical to make patients believing that their private information is for the scientific advancement. (Perry, Linda, Sheryl, et al. 2007). However, the intervention of physicians may not work in the long run unless the researcher is sensitive to the degree of participants' data confidentiality. Despite the risks associated to the research, the proposal is still essential for the older adults seeking emergency services because the outcomes of the research will influence favorable health policy towards older adults seeking health services in the emergency departments. "In medical research ethics, the principles of beneficence and non-maleficence translate into the duties to maximize benefits while minimizing harms, especially for the research subjects." "( (Tangwa, 2009, p S5).

Different strategies the researcher will use in making the participants releasing their information. First, the researcher will counsel the participants on the importance of the proposal to their health benefits, and assure them that all the information collected will be used for the research purpose only and none of their private information will be revealed to the third party. Moreover, the researcher will assure them that none of their personal information such as names, addresses, emails, phone numbers, and other health or non-health information will be released to the public. To ascertain that the participant's information remains confidential, the proposal will use code to identify each participant, which is different from the participants' real names. Additionally, the researcher will assure all the participants that their information will be discarded after the study has been completed.

A report carried out by CIHR (2005) reveals that key ethical challenge facing the health research environment is the strategy to protect the privacy of participants. The CIHR report recommends it is critical for a researcher to limit the personal data collected from participants. This proposal will adhere to the CHIR guideline by collecting only data that will identify participants, and information collected will be restricted to achieve the research objectives. Thus, the proposal will collect the demographic data of the participants to identify their ages to ascertain whether they qualify for the research. Moreover, their address will be collected to ensure that they reside in the New Brunswick.

The researcher will also educate them on different potential benefits to be derived from the proposal. First, the research findings will make the health policy makers to increase the financial resources allotted to the emergency departments in each fiscal year, and the outcomes will make the departments to purchase necessary health materials that will reduce the wait times in the emergency department. (CIHI, 2012). In 2004, the Canada's first minister passed a policy for a 10-year plan to reduce the wait times for cardiac care, cancer treatment, joint replacement, and diagnostic imaging.

"Since the introduction of the 10-Year Plan, progress has been made in reducing wait times. In 2010-2011, about 8 out of every 10 has been made in reducing wait times. In 2010-2011, about 8 out of every 10 patients across Canada received their priority procedures within the patients across Canada received their priority procedures within the Benchmarks." (CIHI, 2011 p 111).

The findings of this research will also influence the policy makers to implement the similar plan to reduce the wait times experienced by the older adults in the emergency departments. A reduction of the wait times will improve the health outcomes of the older adults, which will consequently reduce the number of patients patronizing the emergency departments in New Brunswick. (NBHC, 2013).

Different benefits this study will deliver to patients and overall healthcare community. First, the research procedure will assist the policy makers in New Brunswick to understand the challenges the older adults face when seeking for health services in the emergency departments with regard to the longer wait times and the strategy they can employ to address the problems. (Beverley, Frederick, Paul et al. 2008). Moreover, the research findings will influence the health policy in New Brunswick, which will make the policy makers to increase yearly health budgets for the emergency departments. The outcomes will lead to the increase of the health personnel in the department, which will consequently lower the wait times and lead to an increase in the quality of health delivery in the department.

Complying with the current Tri-Council Guidelines

The proposal will comply to the Tri-Council guideline in case the Partial Disclosure is anticipated. The Tri-Council provides a comprehensive guideline that a researcher should follow in order to adhere to the ethical guidelines. The researcher will follow the Article 3.1 of the Tri-Council that reveals:

"Consent shall be given voluntarily." (Canadian Institute of Health Research, 2014 p 26).

"Consent can be withdrawn at any time." (Canadian Institute of Health Research, 2014 p 26).

"If a participant withdraws consent, the participant can also request the withdrawal of their data or human biological materials." (Canadian Institute of Health Research, 2014 p 26).

Moreover, the research will follow an informed consent stipulated by the Tri-Council where the researcher will inform all participants that their participations in the research is voluntary. Moreover, participants will be informed the potential benefits and risks associated to the research. By following the Tri-Council policy, the researcher will "seek consent from prospective participants, which may result in either agreement or refusal to participate." (Canadian Institute of Health Research, 2014 p 25).

The researcher will inform the prospective participants information about the research. Information will be communicated to them in a plain English language, and will exclude any technical language. Moreover, the researcher will use both oral and written form to communicate the information to them so that the information can be easily understood. (CIHR, 2005).

Moreover, the researcher will exclude all participants who refuse to participate in the research. The researcher will also consult an authorized third party representing participants

"who lack the capacity to decide for themselves should nevertheless have the opportunity to participate in research that may be of benefit to themselves or others. Authorized third parties acting on behalf of these individuals may decide whether participation would be appropriate." (Canadian Institute of Health Research, 2014 p 25).

An authorized third party is an individual who has been allowed by the Canadian legal authority to make appropriate decisions on behalf of individuals "who lacks the capacity to decide whether or not to participate or to continue to participate in a particular research project." (Canadian Institute of Health Research, 2014 p 25).

Moreover, the researcher will disclose all the information to the participants or an authorized third party to make them making an informed decision in order to participate in the project. The researcher will also follow the Article 5.1 of the Tri-Council that reveals:

"Researchers shall safeguard information entrusted to them and not misuse or wrongfully disclose it. Institutions shall support their researchers in maintaining promises of confidentiality." (Canadian Institute of Health Research, 2014 p 60).

The researcher will apply the principles by ensuring that all the information collected from the participants are highly confidential.

Proposed Number of participants & other Special Considerations

The inclusion criteria used for the recruitment of potential participants are as follows:

Patients' participants should be 60 years or older

The participants can be a mixture of male and female

The patients' participants ought to have sought for the services of the emergency department.

The research will also collect data from healthcare professionals working in the emergency departments to understand the potential factors leading to a longer wait times, which will assist in designing solutions to the problems.

The exclusion criteria for the recruitment of participants are as follows:

Patients participant below 60 years will be excluded.

Patients not seeking the services of the emergency departments will be excluded.

Older adults seeking the EDs services in other provinces other than New Brunswick will be excluded.

Precise method Participants will be recruited

"The proposed recruitment procedure and materials should be included in the submission for REB approval." (CHIR, 2005 p 9). The researcher will submit the recruitment procedure to the REB (Research Ethics Board) for approval. The procedure for the recruitment will be voluntary and no undue influence will be exerted to recruit the participants. Moreover, the researcher will use the following criteria to determine the eligibility of the prospective participants:

The researcher will inform the eligible individual such as physicians to inform the prospective participants to release their information for the research purpose. Moreover, the researcher will contact REB to assist in releasing confidential information about the participants under the a legal binding confidential protection agreement. The researcher will make eligible participants to be aware that he has signed a legally binding confidential agreement with the REB. The strategy will make the participants to be at easy when releasing their confidential information.

The participants will be recruited from New Brunswick and all participants must reside in New Brunswick and seek EDs service from one of the hospitals providing ED services. The researcher will collect data from patients of:

Saint John Regional Hospital

Upper River Valley Hospital

The Moncton Hospital, and "Dr. Everett Chalmers Regional Hospital."

All these hospitals offer emergency services and are located in New Brunswick. Participants will be invited through emails and there will be a follow up of telephone conversations. The essence of a telephone conversation is to brief the participants about the importance of the research and potential benefits to be derived from participating.

Method Participants Accessing the Results

The research will submit the results in the EBSCOhost database to be accessed by all participants.

Informed Consent

This section provides the informed consent form, which participants will require to sign to participate in the research. The informed consent form is provided in the Appendix 1.

Feedback to the Research Participants on Research Outcome

The researcher will provide the feedback about the researcher outcomes to the participants through emails or by post. However, the email will be appropriate to send the feedback to the participants because it is more cost effective than by sending it by posts. The researcher will advise the participants with no emails to create emails to receive the research outcomes.

Security of identifiable Personal Data

The PII (Personally identifiable information) is an information that can be used to identify the participants. These information includes names, address, age, and other identifiable information. If the researcher collects some of these information to complete the proposal, the researcher will use different security measures to protect the data.

"The researchers will take a risk assessment and management approach to protecting research data from loss, corruption, theft or unauthorized disclosure, as appropriate for the sensitivity and identifiability of the data." (CIHR, 2005 p 10)

The proposal will use both physical and technological measures to safeguard data collected from participants. First, the researcher will create a Microsoft Access database to store the data, which will be protected with a very strong password. Moreover, the researcher will use an encrypted USB Drive to store the data, and the encryption will change the entire data into a non-readable texts. Afterwards, the researcher will store the USB in a locked box.

PURPOSE OF STUDY

You are being invited to participate in the research study. Before participating in the research, it is important to understand the purpose of this research. Please read the information carefully. Please ask questions if needed more information.

The purpose of this research is to investigate the wait times of Seniors with Ambulatory Care Sensitive Condition in Emergency departments of New Brunswick, Canada.

STUDY PROCEDURES

The procedure is to fill survey form presented to you and be objective in the answers provided.

RISKS

Filling the form will take part of your time. The researcher will need to collect your health information for the research purpose only.

BENEFITS

The research findings will make the policy makers addressing the problems associated to the wait times in the emergency departments, which will consequently assist in reducing the wait times and enhance quality of health care delivery in the EDs.

CONFIDENTIALITY

Your responses will be anonymous. Please do not provide identifying information and every effort will be implemented to preserve all your confidentiality.

CONTACT INFORMATION

Feel free to contact the IRB (Institutional Review Board) at (800) ***

VOLUNTARY PARTICIPATION

Your participation is voluntary, and if you intend to take part, you will be need to sign a consent form. You can still withdraw after signing the form and your data will be deleted after you withdraw.

CONSENT

I have read and understood all the provided information. I understand that my participation in the research is voluntary and I can withdraw any time without providing any reason.

Participant's signature ___ Date

Investigator's signature ___ Date

Providing Feedback to Participants

The researcher will provide the outcomes of the research to all participants through emails or by post.

Appendix 2: Questionnaire Format

The questionnaire format is as follows:

Demographic Data

Address:

City, state, zip:

Telephone:

Date of birth:

Sex (circle): Female -Male

Data about Wait Times Experience in Emergency Department

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree