Moral conflicts among patients-caregivers dyads in oncological care pathway: a systematic review of the ethical literature

Purpose: Cancer patients are most often accompanied by at least one caregiver along the oncological care path. Since cancer has been defined as a “family disease”, patients may rely on caregivers to take medical decisions. In some cases, they arrive at shared decisions, and in other cases, they experience some conflict, with negative implications on the care process. No systematic collection of “moral conflicts”, i.e., conflicts pertaining to ethically related issues, occurring among patients and their caregivers in cancer care path is available in current bioethics literature. Methods: Using PRISMA guidelines, we conducted a systematic review of bioethics literature, broadly considered, in five major databases: PubMed, Web of Science™, PsycINFO, Cinahl and Philosopher’s Index. Titles, abstracts and full texts of identified papers were screened for relevance. The snowball technique and citation tracking were used to identify relevant publications. Data analysis and synthesis were conducted in line with the QUAGOL methodology. Results: Twenty-two publications were included. Publication dates ranged from 1999 to 2021. We distinguished four different types of conflict: “conflict between values”, “conflict between interests”, “conflict related to decisional responsibilities and autonomous decision-making” and “relational conflicts related to existential and/or ontological differences”. Conflict among patients and caregivers can be exacerbated by several factors both related to caregiver’s characteristics, family history and disease. Conclusion: The evidence collected shows the importance of considering also the ethical dimension of the oncological care process, especially in its decisional component.