Formal Academic Training on Ethics May Address Junior Physicians’ Needs

Darmon, Michaël; Ducos, Guillaume; Coquet, Isaline; Resche-Rigon, Matthieu; Pochard, Frédéric; Paries, Marie; Kentish-Barnes, Nancy; Chaize, Marine; Schlemmer, Benoı̂t; Azoulay, Élie

doi:10.1016/j.chest.2016.02.651

Cited by 7 publications

(4 citation statements)

References 37 publications

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“…Education about recent advances in cancer for ICU clinicians and about the limits and consequences of advanced ICU care for hematologists and oncologists could help in increasing mutual trust and quality of care. Formal training in ethics and palliative care has also been found to reduce uncertainty [ 26 ]. Furthermore, our results highlight the need for closed-loops systems in which both ICU clinicians and hematologists or oncologists learn from the results of ICU referrals.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients

Benoît

Zee

Darmon

et al. 2021

Ann. Intensive Care

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Background Whether Intensive Care Unit (ICU) clinicians display unconscious bias towards cancer patients is unknown. The aim of this study was to compare the outcomes of critically ill patients with and without perceptions of excessive care (PECs) by ICU clinicians in patients with and without cancer. Methods This study is a sub-analysis of the large multicentre DISPROPRICUS study. Clinicians of 56 ICUs in Europe and the United States completed a daily questionnaire about the appropriateness of care during a 28-day period. We compared the cumulative incidence of patients with concordant PECs, treatment limitation decisions (TLDs) and death between patients with uncontrolled and controlled cancer, and patients without cancer. Results Of the 1641 patients, 117 (7.1%) had uncontrolled cancer and 270 (16.4%) had controlled cancer. The cumulative incidence of concordant PECs in patients with uncontrolled and controlled cancer versus patients without cancer was 20.5%, 8.1%, and 9.1% (p < 0.001 and p = 0.62, respectively). In patients with concordant PECs, we found no evidence for a difference in time from admission until death (HR 1.02, 95% CI 0.60–1.72 and HR 0.87, 95% CI 0.49–1.54) and TLDs (HR 0.81, 95% CI 0.33–1.99 and HR 0.70, 95% CI 0.27–1.81) across subgroups. In patients without concordant PECs, we found differences between the time from admission until death (HR 2.23, 95% CI 1.58–3.15 and 1.66, 95% CI 1.28–2.15), without a corresponding increase in time until TLDs (NA, p = 0.3 and 0.7) across subgroups. Conclusions The absence of a difference in time from admission until TLDs and death in patients with concordant PECs makes bias by ICU clinicians towards cancer patients unlikely. However, the differences between the time from admission until death, without a corresponding increase in time until TLDs, suggest prognostic unawareness, uncertainty or optimism in ICU clinicians who did not provide PECs, more specifically in patients with uncontrolled cancer. This study highlights the need to improve intra- and interdisciplinary ethical reflection and subsequent decision-making at the ICU.

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Section: Discussionmentioning

confidence: 99%

Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients

Benoît

Zee

Darmon

et al. 2021

Ann. Intensive Care

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“…We implemented a pre-post evaluation [32,33] of the training after adopting a specific methodology, which led us to describe the development of new knowledge, new awareness and changes in both performance and competence [34]. On the contrary, most of the training programmes described by literature have been evaluated only in terms of participants' perception and satisfaction [5,12,13].…”

Section: Discussionmentioning

confidence: 99%

“Teach for ethics in palliative care”: a mixed-method evaluation of a medical ethics training programme

et al. 2020

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Background Training in medical ethics aims to educate health care professionals in dealing with daily care ethical issues. To guarantee quality of life and spiritual and emotional support, palliative care professionals have to develop ethical and relational skills. We propose the implementation and evaluation of a specialized training programme in medical ethics dedicated to a hospital-based Palliative Care Unit. Methods This study is a mixed-method before-after evaluation with data triangulation. Results The results highlight that participants developed their ethical knowledge, and a deeper ethical awareness. They also felt more confident and motivated to widely apply ethical reflections and reasonings in their daily practice. Conclusion The participants appreciated the innovative structure of the training, especially regarding the integration of the theoretical-interactive and practical parts. However, they recommended increasing the number of concrete occasions for ethical supervision and practical application of what they learned during the programme. The training programme also has some potential practical implications: the development of advanced ethical skills within a hospital-based PC team may improve the quality of life of the patients and their families. In addition, health care professionals with advanced ethical competencies are able to educate patients and their families towards more active participation in the decision-making process.

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“…When physicians are busy or unprepared to respond to these emotions, the desire to maintain a cordial relationship with a patient or their family may influence decisions about when to disclose prognosis and inform patients of the option to prioritize comfort rather than longevity. [41] Maintaining relationships with colleagues in nursing is also a consideration. For example, removing urinary catheters or peripheral intravenous access as soon as possible is generally in the best interest of patients because this decreases the risk of infection.…”

Section: Interests Of Physiciansmentioning

confidence: 99%

Competing and conflicting interests in the care of critically ill patients

et al. 2018

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Medical professionals are expected to prioritize patient interests, and most patients trust physicians to act in their best interest. However, a single patient is never a physician's sole concern. The competing interests of other patients, clinicians, family members, hospital administrators, regulators, insurers, and trainees are omnipresent. While prioritizing patient interests is always a struggle, it is especially challenging and important in the ICU setting where most patients lack the ability to advocate for themselves or seek alternative sources of care. This review explores factors that increase the risk, or the perception, that an ICU physician will reason, recommend, or act in a way that is not in their patient's best interest and discusses steps that could help minimize the impact of these factors on patient care.

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Formal Academic Training on Ethics May Address Junior Physicians’ Needs

Cited by 7 publications

References 37 publications

Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients

Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients

“Teach for ethics in palliative care”: a mixed-method evaluation of a medical ethics training programme

Competing and conflicting interests in the care of critically ill patients

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