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

Abstract

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.

Analysis of Presentations and Outcomes of Care of Children with Disorders of Sexual Development in a Nigerian Hospital

“…African value systems typically honor and uphold the value of family autonomy over individual autonomy. 26 Equally, one needs to consider cost of care and poor long-term follow-up in our setting, because of transport and other socioeconomic factors. Because the upbringing in these communities is communal-based, an early decision on the gender of rearing is essential and assists early integration of the child into the society.…”

Ethical Issues Recognized by Critical Care Nurses in the Intensive Care Units of a Tertiary Hospital during Two Separate Periods

“…Studdert et al ( 8 ) reported that conflicts occurred for nearly one-third of patients with prolonged ICU stays during their hospitalization. However, conflict incidence seems to be low in other studies that have investigated the effect of ethical intervention for ICU patients ( 20 , 21 ). In a study on adult ICUs of seven US hospitals during 26 months, 551 cases were involved in ethical conflicts ( 21 ).…”

“…In a study on adult ICUs of seven US hospitals during 26 months, 551 cases were involved in ethical conflicts ( 21 ). In a study of Asian country, Chen et al ( 20 ) identified only 65 cases involving ethics consultation in a large hospital over 30 months. We also observed a relatively low incidence of cases with ethical issues from the point of ICU nurses.…”

Evaluation of a paediatric clinical ethics service

“…Interventional studies are the gold standard for testing efficacy but must be designed and interpreted carefully in this context. There are two randomised controlled trials and one prospective cohort study testing efficacy of CES in the intensive care setting . All found that CES decreased length of stay and the duration of life‐sustaining measures in patients who did not survive to discharge.…”