Diagnosis and follow-up of IPMNS of the pancreas - bringing the ethical issues into focus.

BACKGROUND: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas present a broad spectrum of biological behavior, ranging from benign to malignant. Their management poses significant ethical dilemmas, particularly concerning diagnostic uncertainty, the risk of overdiagnosis and overtreatment, and resource allocation. METHODS: This qualitative study employed a constructivist approach to explore the ethical challenges faced by surgeons in managing IPMNs. Data were collected through focus group meetings (FGMs) with members of an expert working group at the Verona Evidence-Based Meeting on IPMNs (2020). Discussions were analyzed to identify key ethical concerns. RESULTS: The analysis highlighted several major ethical concerns: (1) decision-making under diagnostic uncertainty, (2) ethical challenges in patient communication, (3) overdiagnosis and over-surveillance due to defensive medicine and patient anxiety, (4) overtreatment through unnecessary surgery, and (5) issues of distributive justice in access to care and healthcare resource utilization. Participants emphasized the difficulty of balancing transparency with the need to minimize psychological distress in patients, as well as the challenge of applying international guidelines in diverse healthcare settings. CONCLUSIONS: Ethical decision-making in IPMN management requires balancing the risks of malignancy with the potential harms of overtreatment, while also considering patient autonomy and resource limitations. Enhancing decision-support tools, improving surgeon training in communication, and refining clinical guidelines to incorporate ethical considerations may help address these challenges. Further research is needed to develop strategies for more individualized and patient-centered care.