Pediatricians' Experience with Clinical Ethics Consultation: A National Survey

Morrison, Wynne; Womer, James; Nathanson, Pamela; Kersun, Leslie S.; Hester, D. Micah; Walsh, B. Corbett; Feudtner, Chris

doi:10.1016/j.jpeds.2015.06.047

Cited by 28 publications

(24 citation statements)

References 46 publications

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“…Although our low response rate increases the risk of non-response bias, it is consistent with that of similar studies involving email surveys of nurses and physicians 9 14 17 22. In general, physicians tend to be a low-responding group 22. Using email to distribute surveys allowed us to obtain a larger and possibly more diverse group of respondents among three EDs.…”

Section: Discussionmentioning

confidence: 99%

Ethics consultation in paediatric and adult emergency departments: an assessment of clinical, ethical, learning and resource needs

et al. 2017

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Nurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists.

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Section: Discussionmentioning

confidence: 99%

Ethics consultation in paediatric and adult emergency departments: an assessment of clinical, ethical, learning and resource needs

et al. 2017

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“…Despite two reminders, our response rate was 22.0%, not accounting for messages that were electronically filtered. Low response rates are a risk of survey research; however, we have higher response rate 20 and total number of responses 21 than recently published surveys. We collected the opinions of almost a quarter of the practicing pediatric intensivists across North America.…”

Section: Discussionmentioning

confidence: 83%

A Survey of Pediatric Critical Care Providers on the Presence, Severity, and Assessment of Capillary Leak in Critically Ill Children

Pierce

Luckett

Faustino

2016

J Pediatr Intensive Care

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Purpose To determine provider opinions on factors most commonly used to assess the presence and severity of pathologic capillary leak in critically ill children. Methods We conducted an electronic survey of pediatric critical care providers. Patient scenarios were presented to assess opinions on the risk, presence, and clinical significance of capillary leak. Responses were obtained using Likert scales and multiple-choice questions. Results A total of 160 responses were analyzed. Respondents agreed that capillary leak is present in the scenario with septic shock while respondents somewhat agreed that it is also present with poly-trauma, cardiac arrest, or cardiopulmonary bypass. They agreed that physical exam, but neither agreed nor disagreed that laboratory tests, can be used to assess and follow the severity of capillary leak in these children. Generalized edema, increase in weight, and pulmonary crackles were commonly identified parameters for assessing capillary leak. The patient factor most commonly identified with capillary leak was presence of infection, while treatment factors most commonly identified were cardiopulmonary bypass and general anesthesia. Conclusion There is agreement that capillary leak is common in critically ill children and exacerbates disease. The parameters identified in this study may facilitate a more standardized clinical evaluation of pathologic capillary leak for future studies.

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“…Researchers have offered a multitude of reasons for the low incidence of ethics consultations in pediatrics. They have hypothesized that clinicians are unaware that ethics consultations are available or do not know how to request them, that medical teams feel they can address ethical issues without help, that clinicians perceive a lack of qualifications among ethics consultants, or that residents and nurses worry about repercussions from the attending physician . Carter et al propose that ethical dilemmas may also be addressed in different forums outside the realm of the traditional ethics consultation .…”

Section: Discussionmentioning

confidence: 99%

Content review of pediatric ethics consultations at a cancer center

Winter

Friedman

McCabe

et al. 2019

Pediatric Blood & Cancer

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Background/objectives Ethical challenges in pediatric oncology arise at every stage of illness. However, there are sparse data on the content of and reason for ethics consultations in the field. We sought to evaluate the content and characteristics of ethics consultations in pediatric patients at a cancer center. Design/methods We retrospectively identified ethics consultations performed for patients diagnosed with cancer at ≤21 years of age who were treated in the Department of Pediatrics from 2007 to 2017. Using an established coding schema, two independent reviewers analyzed the content of ethics consultation notes and identified core ethical issues and relevant contextual issues. Demographic, clinical, and consultation‐specific data were also collected. Results Thirty‐five consultations were performed for 32 unique patients. The most commonly identified ethical issues were obligation to provide nonbeneficial treatment (29%) and resuscitation preferences (26%). Communication conflicts were the most commonly identified contextual issue (40%). There were two themes that emerged repeatedly but were not a part of the original coding schema—four consultations (11%) that involved physicians questioning their obligation to provide potentially toxic treatment in the setting of poor patient/parent compliance, and two consultations (6%) related to complex risk‐benefit analysis in the setting of an invasive procedure with uncertain benefit. Conclusions Pediatric ethics consultations are infrequent at this specialty cancer hospital. Ethical issues focused on treatment and end‐of‐life care and included a diversity of communication conflicts.

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Pediatricians' Experience with Clinical Ethics Consultation: A National Survey

Cited by 28 publications

References 46 publications

Ethics consultation in paediatric and adult emergency departments: an assessment of clinical, ethical, learning and resource needs

Ethics consultation in paediatric and adult emergency departments: an assessment of clinical, ethical, learning and resource needs

A Survey of Pediatric Critical Care Providers on the Presence, Severity, and Assessment of Capillary Leak in Critically Ill Children

Content review of pediatric ethics consultations at a cancer center

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