An Embedded Model for Ethics Consultation: Characteristics, Outcomes, and Challenges

Bruce, Courtenay R.; Peña, Adam; Kusin, Betsy B.; Allen, Nathan G.; Smith, Martin L.; Majumder, Mary A.

doi:10.1080/23294515.2014.889775

Cited by 27 publications

(17 citation statements)

References 30 publications

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“…This is notable as the respondents were expected to attend PEACE Rounds if they were an assigned care provider for a patient who was being discussed and the response rate for these surveys was greater than 90%. As in previous work (Bruce et al, 2014;Cohn et al, 2007), clinicians appreciated the proactive ethics approach;…”

Section: Discussionsupporting

confidence: 53%

“…There is some indication that promoting open discussion about ethically challenging situations will lower moral distress (Bruce et al, 2014: Karanikola et al, 2014Wocial et al, 2010).…”

mentioning

confidence: 99%

“…A clinical ethicist can promote genuine dialogue between health care professionals who must explore difficult choices when caring for patients who experience life-threatening illness (Bruce et al, 2014: Cohn et al, 2007Dowdy et al, 1998).…”

mentioning

confidence: 99%

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Pediatric Ethics and Communication Excellence (PEACE) Rounds: Decreasing Moral Distress and Patient Length of Stay in the PICU

et al. 2016

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Innovation: Establish formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers' moral distress and decreases length of stay for patients with lifethreatening illnesses.Evaluation: Pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls.Setting: Pediatric Intensive Care Unit in a quaternary care Children's Hospital. Participants: Physicians and nurses on staff in the unit.Patients: There were 60 patients in the interventional and 66 patients in the historical control group.Intervention: Over a year, weekly meetings (PEACE rounds) to establish goals of care for patients with longer than 10 days length of stay in the ICU. Results:Moral distress scores measured intermittently with the MDT fluctuated. "Clinical situations" represented the most frequent contributing factor to moral distress. Post intervention, overall MDS-R scores were lower for respondents in all categories (non-significant), and on three specific items (significant). Patient outcomes before and after PEACE intervention showed a statistically significant decrease in PRISM indexed LOS (4.94 control vs 3.37 PEACE, p=0.015), a statistically significant increase in both code status changes DNR (11% control, 28% PEACE, p=0.013), and in-hospital death (9% control, 25% PEACE, p=0.015), with no change in patient 30 or 365 day mortality. Conclusion:The addition of a clinical ethicist and senior intensivist to weekly interprofessional team meetings facilitates difficult conversations regarding realistic goals of care. The PEACE

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Section: Discussionsupporting

confidence: 53%

“…There is some indication that promoting open discussion about ethically challenging situations will lower moral distress (Bruce et al, 2014: Karanikola et al, 2014Wocial et al, 2010).…”

mentioning

confidence: 99%

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Pediatric Ethics and Communication Excellence (PEACE) Rounds: Decreasing Moral Distress and Patient Length of Stay in the PICU

et al. 2016

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“…Other questions raised in the bioethics literature include appropriate resource allocation, given the expense and personnel required for this therapy; whether discussions of ECMO candidacy should involve patients and their surrogates or whether these decisions can be made without their explicit input; whether it is justified to have patients or their surrogates sign documents stating that the circuit will be withdrawn if the ECMO-specific goals are not met; whether it is appropriate to continue ECMO in brain-dead potential organ donors; and whether hospitals without ECMO capability have an obligation to transfer patients to regional ECMO centers (8,9) Despite ongoing discussions of the unique ethical dimensions of ECMO, little has been written about the role of hospital ethics committees in navigating the actual clinical ECMO experience (10). In their case consultation and organizational ethics roles, ethics committees are an important and underused resource in addressing the predictable consequences of introducing a new life-sustaining medical technology.…”

mentioning

confidence: 99%

Ethics Committee Consultation and Extracorporeal Membrane Oxygenation

et al. 2016

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Rationale: The clinical ethics literature on extracorporeal membrane oxygenation (ECMO) has been focused primarily on identifying hypothetical ethical dilemmas that may arise with the use of this technology. Little has been written on the actual experience with ECMO-related ethical questions.Objectives: To describe the role of an ethics consultation service during the expansion of a single-center ECMO program in a cardiothoracic surgery intensive care unit (CSICU) and to identify common ethical themes surrounding the use of ECMO. Methods:We conducted a retrospective, descriptive cohort study of all ECMO ethics consultation cases in the CSICU at a large academic hospital between 2013 and 2015.Measurements and Main Results: During the study period, 113 patients were placed on ECMO in the CSICU, 45 (39.5%) of whom were seen by the ethics committee. In 2013, 10 of 46 (21.7%) patients received ethics consults. By 2015, 28 of 30 (93.3%) of patients were seen by ethics consultants. Initial consultation occurred at a median of 2 days (interquartile range, 1-6 d) following initiation of ECMO. The most common ethical issue involved disagreement about the ongoing use of ECMO, which included multiple axes: Disagreement among health care providers, disagreement among surrogates, and disagreement between health care providers and surrogates over stopping or continuing ECMO.Conclusions: In our experience with integrating ethics consultation into the routine care of ECMO patients, most of the ethical questions more closely resembled traditional concerns about the appropriate use of any life-sustaining treatment rather than the novel dilemmas imagined in the current literature.

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“…35 It is suggested that embedding a clinical ethicist in the interprofessional team can promote the dialog between medical professionals who must explore difficult choices. 45 Morally distressing situations almost always involve an interdisciplinary issue, such as a lack of effective communication between team members, or uncertainty about which medical service team is responsible. The inclusion of nurses in interdisciplinary rounds can help strengthen collaboration and communication when ethical issues arise and may subsequently reduce triggers of moral distress.…”

Section: Moral Distressmentioning

confidence: 99%

The ethical dilemma of placebo use in clinical practice

Yuan

2020

Frontiers of Nursing

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The clinical use of placebo that involves some ethical issues has led to much controversy. From the standpoint of both supporters and opponents, this article discusses this topic from three ethical principles such as beneficence, justice, and autonomy and also gives the recommendations. Finally, the moral dilemma caused by the different views between nurses and doctors in clinical practice is discussed.

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An Embedded Model for Ethics Consultation: Characteristics, Outcomes, and Challenges

Cited by 27 publications

References 30 publications

Pediatric Ethics and Communication Excellence (PEACE) Rounds: Decreasing Moral Distress and Patient Length of Stay in the PICU

Pediatric Ethics and Communication Excellence (PEACE) Rounds: Decreasing Moral Distress and Patient Length of Stay in the PICU

Ethics Committee Consultation and Extracorporeal Membrane Oxygenation

The ethical dilemma of placebo use in clinical practice

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