Clinical Ethics Consultation During the First COVID-19 Pandemic Surge at an Academic Medical Center: A Mixed Methods Analysis

Erler, Kimberly; Robinson, Ellen M.; Bandini, Julia; Regel, Eva V.; Zwirner, Mary; Cremens, Cornelia M.; McCoy, Thomas H.; Romain, Fred; Courtwright, Andrew

doi:10.1007/s10730-022-09474-y

Cited by 6 publications

(6 citation statements)

References 27 publications

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“…Cancer and COVID-19 had significantly longer times to consult than other diagnoses, consistent with the hypothesis that consults for these diagnoses were centered around end-of-life care due to the often terminal nature of cancer and the drawn-out hospital courses of patients with COVID-19. This was consistent with our data demonstrating that ethics consults for patients with COVID-19 diagnoses had among the highest rates of recommendations to make DNR or transition to comfort care, consistent with a prior study highlighting ethics consults related to end-of-life care in patients with COVID-19 [ 17 ]. However, more data is needed to draw significant conclusions on causal relationships between principal diagnosis and time to ethics consultation.…”

Section: Discussionsupporting

confidence: 93%

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Characterization of patients requiring inpatient hospital ethics consults- A single center study

Mahadevan,

Azizi,

Dastur

et al. 2024

PLoS ONE

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Introduction Ethics consultations are often needed at difficult junctures of medical care. However, data on the nature of how patient characteristics, including race/ethnicity, language, and diagnosis, affect ethics consult outcomes are lacking. Methods We performed a retrospective cohort study of all patients who were seen by the Ethics Consult Service between 2017 and 2021 at a large tertiary academic center with the aim of determining whether patient demographic and clinical factors were associated with the timing of ethics consult requests and recommendations of the ethics team. Results We found that patients admitted for COVID-19 had significantly longer median times to consult from admission compared with other primary diagnoses (19 vs 8 days respectively, p = 0.015). Spanish-speaking patients had longer median times to consult from admission compared to English speaking patients (20 vs 7 days respectively, p = 0.008), indicating that language barriers may play a role in the timing of ethics consultation. Conclusions This study demonstrates the need to consider clinical and demographic features when planning and prioritizing ethics consultations at large institutions to enhance consult efficiency, resource utilization, and patient experience and autonomy.

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Section: Discussionsupporting

confidence: 93%

“…However, COVID-19 accounted for 18.2% of our consults from 2020–2021, which made it the most common diagnosis eliciting an ethics consult during those years. This was substantially lower than the 44.9% rate found during a study conducted at the onset of the COVID-19 pandemic (March–June 2020) [ 17 ].…”

Section: Discussionmentioning

confidence: 58%

Characterization of patients requiring inpatient hospital ethics consults- A single center study

Mahadevan,

Azizi,

Dastur

et al. 2024

PLoS ONE

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“…A total of 119 [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 8...…”

Section: Resultsunclassified

“…The following supporting information can be downloaded at: , File S1: Excel spreadsheet containing complete metadata of references retrieved for description and Analysis of Research on Death and Dying during the COVID-19 Pandemic, Published in Nursing Journals Indexed in SCOPUS. (References [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 …”

mentioning

confidence: 99%

Description and Analysis of Research on Death and Dying during the COVID-19 Pandemic, Published in Nursing Journals Indexed in SCOPUS

Cuellar-Pompa,

Rodríguez-Gómez,

Novo-Muñoz

et al. 2024

Nursing Reports

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Aim: To offer an overall picture of the research published regarding the different aspects of death and dying during the COVID-19 pandemic in journals covering the field of nursing in the Scopus database. Design: bibliometric analysis. Methods: The metadata obtained were exported from Scopus for subsequent analysis through Bibliometrix. Using the VOSviewer co-word analysis function, the conceptual and thematic structure of the publications was identified. Results: A total of 119 papers were retrieved, with the participation of 527 authors. The publications were found in 71 journals covering the nursing area. The main lines of research revolved around the keywords “palliative care” and “end-of-life care” in regard to the ethical, psychological, and organizational challenges faced by the health professionals who cared for these patients. Conclusion: The results obtained offer a range of data and images that characterize the scientific production published on this topic, coming to the conclusion that, due to the multifaceted and multidisciplinary approach to the experience of death, care, and accompaniment in the dying process, bibliometric maps improve the comprehensive understanding of the semantic and conceptual structure of this field of research. This study was retrospectively registered with the OSF Registries on the 14 March 2024.

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“…Identifying themes related to prognostic difficulty, challenges in visitor restrictions, and end-of-life scenarios, and the study provides practical insights. Nevertheless, the lack of a significant difference in consultation cases and reliance on retrospective data may constrain the generalizability of the findings [10]. Venturing into the controversial terrain of medical aid in dying, Kious BM conducted a philosophical evaluation of the impact of injustice on hard choices.…”

Section: Study Selectionmentioning

confidence: 99%

Ethical Dimensions in Contemporary Medical Practices: A Systematic Review and Analysis of Diverse Perspectives

2023

ABCA

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Objective: This systematic review and analysis aim to comprehensively explore diverse ethical perspectives within contemporary medical practices. Acknowledging the complexity of ethical considerations in medicine influenced by cultural, socio-economic, and legal factors, the objective is to synthesize insights from various studies and delve into key themes such as patient autonomy, informed consent, healthcare equity, and the ethical implications of emerging technologies. Methodology: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 2020, this analysis systematically reviewed scholarly articles focusing on ethical considerations within modern medical practices from 2020 to 2023. A thorough screening process, based on specific Medical Subject Headings (MeSH) terms, was conducted in major databases (PubMed, Scopus, Web of Knowledge, and Google Scholar). Eleven relevant studies were included, representing diverse perspectives and ethical frameworks. Result: The systematic study selection process identified 11 relevant studies from an initial pool of 297 records. These studies covered a range of topics, including parental decision-making for adolescents with mental health issues, the legalization of medical cannabis, challenges in patient care during the COVID-19 pandemic and medical education ethics. The included studies were subjected to a meticulous evaluation of their characteristics, outcomes, and limitations. The findings contribute valuable insights into the multifaceted ethical dimensions of contemporary medical practices. Conclusion: This systematic review and analysis provide a comprehensive overview of diverse ethical perspectives inherent in contemporary medical practices. While recognizing the complexity of medical ethics, influenced by various factors, the study identifies patterns, gaps and divergent viewpoints within the selected studies. The analysis aims to inform practitioners, policymakers, and scholars engaged in ethical decision-making in healthcare, fostering a more informed and ethically robust approach to modern medical practices. Despite the limitations in some studies, the findings contribute to the ongoing discourse on medical ethics and highlight the need for further research and dialogue to address evolving ethical challenges in healthcare.

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Clinical Ethics Consultation During the First COVID-19 Pandemic Surge at an Academic Medical Center: A Mixed Methods Analysis

Cited by 6 publications

References 27 publications

Characterization of patients requiring inpatient hospital ethics consults- A single center study

Characterization of patients requiring inpatient hospital ethics consults- A single center study

Description and Analysis of Research on Death and Dying during the COVID-19 Pandemic, Published in Nursing Journals Indexed in SCOPUS

Ethical Dimensions in Contemporary Medical Practices: A Systematic Review and Analysis of Diverse Perspectives

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