Caring for Pregnant Patients with Cancer: A Framework for Ethical and Patient-Centred Care.

Simple Summary: Cancer treatment during pregnancy can raise many difficult questions. Currently available clinical practice guidelines offer very limited ethical guidance for healthcare professionals. This article offers a theoretical framework and a practical ethics checklist for ethical and patient-centred care. It takes a holistic view to patient treatment, care and counselling that emphasises the need to recognise the relational context of individual patient's autonomy; balance maternal and foetal beneficence obligations; balance maternalistic and relational approaches to evidence-based personalised patient care; consider protection of the vulnerable in light of responsibilities towards the unborn; and ensure reasonable and just resource allocation. At the moment, very few studies have explored clinicians' attitudes and patients' experiences when cancer treatment is delivered during pregnancy. Therefore, future work will require patient engagement to develop ethical guidance in this setting. (1) Background: Caring for pregnant cancer patients is clinically and ethically complex. There is no structured ethical guidance for healthcare professionals caring for these patients. (2) Objective: This concept paper proposes a theoretically grounded framework to support ethical and patient-centred care of pregnant cancer patients. (3) Methodological approach: The framework development was based on ethical models applicable to cancer care during pregnancy—namely principle-based approaches (biomedical ethics principles developed by Beauchamp and Childress and the European principles in bioethics and biolaw) and relational, patient-focused approaches (relational ethics, ethics of care and medical maternalism)—and informed by a systematic review of clinical practice guidelines. (4) Results: Five foundational discussion themes, summarising the key ethical considerations that should be taken into account by healthcare professionals while discussing treatment and care options with these patients, were identified. This was further developed into a comprehensive ethics checklist that can be used during clinical appointments and highlights the need for a holistic view to patient treatment, care and counselling while providing ethical, patient-centric care. (5) Conclusion: The proposed framework was further operationalised into an ethics checklist for healthcare professionals that aims to help them anticipate and address ethical concerns that may arise when attending to pregnant cancer patients. Further studies exploring clinicians' attitudes towards cancer treatment in the course of pregnancy and patient experiences when diagnosed with cancer while pregnant and wider stakeholder engagement are needed to inform the development of further ethical, patient-centred guidance. [ABSTRACT FROM AUTHOR]