title: Ethical behaviour in clinical practice: a multidimensional Rasch analysis from a survey of primary health care professionals of Barcelona (Catalonia, Spain).
abstract: OBJECTIVE
  Normative ethics includes ethical behaviour health care professionals should uphold in daily practice. This study assessed the degree to which primary health care (PHC) professionals endorse a set of ethical standards from these norms.
  
  
  METHODS
  Health care professionals from an urban area participated in a cross-sectional study. Data were collected using an anonymous, self-administered questionnaire. We examined the level of ethical endorsement of the items and the ethical performance of health care professionals using a Rasch multidimensional model. We analysed differences in ethical performance between groups according to sex, profession and knowledge of ethical norms.
  
  
  RESULTS
  A total of 452 Professionals from 56 PHC centres participated. The level of ethical performance was lower in items related to patient autonomy and respecting patient choices. The item estimate across all dimensions showed that professionals found it most difficult to endorse avoiding interruptions when seeing patients. We found significant differences in two groups: nurses had greater ethical performance than family physicians (p < 0.05), and professionals who reported having effective knowledge of ethical norms had a higher level of ethical performance (p < 0.01).
  
  
  CONCLUSIONS
  Paternalistic behaviour persists in PHC. Lesser endorsement of items suggests that patient-centred care and patient autonomy are not fully considered by professionals. Ethical sensitivity could improve if patients are cared for by multidisciplinary teams.
authors.affiliation: Les Corts Primary Health Care Centre, Transverse Group for Research in Primary Care-IDIBAPS, Barcelona, Spain, gonzalezdepaz@hotmail.com.
authors.forename: Luis
authors.initials: L
authors.lastname: González-de Paz
authors.forename: Belchin
authors.initials: B
authors.lastname: Kostov
authors.forename: Jose A
authors.initials: JA
authors.lastname: López-Pina
authors.forename: Adelaida
authors.initials: A
authors.lastname: Zabalegui-Yárnoz
authors.forename: M Dolores
authors.initials: MD
authors.lastname: Navarro-Rubio
authors.forename: Antoni
authors.initials: A
authors.lastname: Sisó-Almirall
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D026690:Ethics, Clinical; D005260:Female; D006282:Health Personnel / Q000941:ethics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000941:ethics*; D011788:Quality of Life; D013030:Spain; D011795:Surveys and Questionnaires; D055815:Young Adult