Dissatisfaction with Ethics Consultations: The Anna Karenina  Principle

Schneiderman, Lawrence J.; Gilmer, Todd; Teetzel, Holly; Dugan, Daniel O.; Goodman-Crews, Paula; Cohn, Felicia

doi:10.1017/s0963180106060117

Cited by 29 publications

(19 citation statements)

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“…Many of these studies reported findings on physician satisfaction [11,12,15,16], and physician’s perception of clarifying ethical issues, educating the health care team, making clinical decisions with confidence, and in patient management [18]. However, the satisfaction or perception of the parties involved may be influenced by factors not associated with the quality of the HCEC conducted [17,22]. For example, a physician may be satisfied with the HCEC service provided because his/her suggestion is adopted by the ethics consultant and not because of the quality of the HCEC service.…”

Section: Discussionmentioning

confidence: 99%

To evaluate the effectiveness of health care ethics consultation based on the goals of health care ethics consultation: a prospective cohort study with randomization

et al. 2014

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BackgroundThe growing prevalence of health care ethics consultation (HCEC) services in the U.S. has been accompanied by an increase in calls for accountability and quality assurance, and for the debates surrounding why and how HCEC is evaluated. The objective of this study was to evaluate the effectiveness of HCEC as indicated by several novel outcome measurements in East Asian medical encounters.MethodsPatients with medical uncertainty or conflict regarding value-laden issues, and requests made by the attending physicians or nurses for HCEC from December 1, 2009 to April 30, 2012 were randomly assigned to the usual care group (UC group) and the intervention group (HCEC group). The patients in the HCEC group received HCEC conducted by an individual ethics consultant. Data analysis was based on the intention-to-treat principle. Mann–Whitney test and Chi-squared test were used depending on the scale of measurement.ResultsThirty-three patients (53.23%) were randomly assigned to the HCEC group and 29 patients were randomly assigned to the UC group. Among the 33 patients in the HCEC group, two (6.06%) of them ultimately did not receive a HCEC service. Among the 29 patients in the UC group, four (13.79%) of them received a HCEC service. The survival rate at hospital discharge did not differ between the two groups. Patients in the HCEC group showed significant reductions in the entire ICU stay and entire hospital stay. HCEC significantly facilitated achieving the goal of medical care (p < .01). Furthermore, patients in the HCEC group had a shorter ICU stay and shorter hospital stay after the occurrence of medical uncertainty or conflict regarding value-laden issues than those in the UC group.ConclusionsOur findings demonstrated that HCEC were associated with reduced consumption of medical resources as indicated by shorter entire ICU stay, entire hospital stay, and shorter ICU and hospital stay after the occurrence of the medical uncertainty or conflict regarding value-laden issues. This study also showed that HCEC facilitated achieving a consensus regarding the goal of medical care, which conforms to the goal of HCEC.

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Section: Discussionmentioning

confidence: 99%

To evaluate the effectiveness of health care ethics consultation based on the goals of health care ethics consultation: a prospective cohort study with randomization

et al. 2014

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“…Appraisals by external CEC members not involved in the particular CECons [76,99,108,128,129] iii. Feedback from patients and family members [14,69,74,91,92,114,130,131] iv. Input from healthcare professionals [5,14,15,33,72,74,80,85,87,90,91,98,103,111,112,114,118,119,127,130] v. Evaluations by senior clinicians [82,84,93,102,104,127] vi.…”

Section: Methods Of Assessmentmentioning

confidence: 99%

Evaluating assessment tools of the quality of clinical ethics consultations: a systematic scoping review from 1992 to 2019

et al. 2020

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Background: Amidst expanding roles in education and policy making, questions have been raised about the ability of Clinical Ethics Committees (CEC) s to carry out effective ethics consultations (CECons). However recent reviews of CECs suggest that there is no uniformity to CECons and no effective means of assessing the quality of CECons. To address this gap a systematic scoping review of prevailing tools used to assess CECons was performed to foreground and guide the design of a tool to evaluate the quality of CECons. Methods: Guided by Levac et al's (2010) methodological framework for conducting scoping reviews, the research team performed independent literature reviews of accounts of assessments of CECons published in six databases. The included articles were independently analyzed using content and thematic analysis to enhance the validity of the findings. Results: Nine thousand sixty-six abstracts were identified, 617 full-text articles were reviewed, 104 articles were analyzed and four themes were identifiedthe purpose of the CECons evaluation, the various domains assessed, the methods of assessment used and the long-term impact of these evaluations. Conclusion: This review found prevailing assessments of CECons to be piecemeal due to variable goals, contextual factors and practical limitations. The diversity in domains assessed and tools used foregrounds the lack of minimum standards upheld to ensure baseline efficacy. To advance a contextually appropriate, culturally sensitive, program specific assessment tool to assess CECons, clear structural and competency guidelines must be established in the curation of CECons programs, to evaluate their true efficacy and maintain clinical, legal and ethical standards.

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“…Several studies examine stakeholder satisfaction, which is generally found to be high–with health professionals giving the highest scores and next of kin and patients somewhat lower, but still mainly positive 3 4. In Schneiderman et al ’s multicentre study from an intensive care unit setting, ethics consultation received a positive evaluation by more than 90% of health professionals and 80% of patient surrogates 5…”

Section: Introductionmentioning

confidence: 99%

Importance of systematic deliberation and stakeholder presence: a national study of clinical ethics committees

et al. 2019

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BackgroundCase consultation performed by clinical ethics committees (CECs) is a complex activity which should be evaluated. Several evaluation studies have reported stakeholder satisfaction in single institutions. The present study was conducted nationwide and compares clinicians’ evaluations on a range of aspects with the CEC’s own evaluation.MethodsProspective questionnaire study involving case consultations at 19 Norwegian CECs for 1 year, where consultations were evaluated by CECs and clinicians who had participated.ResultsEvaluations of 64 case consultations were received. Cases were complex with multiple ethical problems intertwined. Clinicians rated the average CEC consult highly, being both satisfied with the process and perceiving it to be useful across a number of aspects. CEC evaluations corresponded well with those of clinicians in a large majority of cases. Having next of kin/patients present was experienced as predominantly positive, though practised by only half of the CECs. The educational function of the consult was evaluated more positively when the CEC used a systematic deliberation method.ConclusionsCEC case consultation was found to be a useful service. The study is also a favourable evaluation of the Norwegian CEC system, implying that it is feasible to implement well-functioning CECs on a large scale. There are good reasons to involve the stakeholders in the consultations as a main rule.

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Dissatisfaction with Ethics Consultations: The Anna Karenina Principle

Abstract: We gratefully acknowledge the contributions of Jeffrey Blustein, Kathleen B. Briggs, Ronald Cranford, Glen I. Komatsu, and Ernle W.D. Young to the original randomized controlled trial phase of this research. Grant support came from the

Cited by 29 publications

References 1 publication

To evaluate the effectiveness of health care ethics consultation based on the goals of health care ethics consultation: a prospective cohort study with randomization

To evaluate the effectiveness of health care ethics consultation based on the goals of health care ethics consultation: a prospective cohort study with randomization

Evaluating assessment tools of the quality of clinical ethics consultations: a systematic scoping review from 1992 to 2019

Importance of systematic deliberation and stakeholder presence: a national study of clinical ethics committees

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