Pediatricians' Experience with Clinical Ethics Consultation: A聽National聽Survey

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• 作者：Wynne Morrison ; MD ; MBE¹ ; ² ; ^{morrisonw@email.chop.edu" class="auth_mail" title="E-mail the corresponding author} ; James Womer ; BA¹ ; ³ ; Pamela Nathanson ; MBE⁴ ; Leslie Kersun ; MD ; MSCE⁴ ; D. Micah Hester ; PhD⁵ ; Corbett Walsh ; MBE⁶ ; Chris Feudtner ; MD ; MPH ; PhD¹ ; ⁴
• 关键词：AAP ; American Academy of Pediatrics ; ICU ; Intensive care unit
• 刊名：The Journal of Pediatrics
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：167
• 期：4
• 页码：919-924.e1
• 全文大小：408 K

文摘

To conduct a national survey of pediatricians' access to and experience with clinical ethics consultation.

bsSec_2">Study design

bspara0015">We surveyed a randomly selected sample of 3687 physician members of the American Academy of Pediatrics. We asked about their experiences with ethics consultation, the helpfulness of and barriers to consultation, and ethics education. Using a discrete choice experiment with maximum difference scaling, we evaluated which traits of ethics consultants were most valuable.

bsSec_3">Results

bspara0020">Of the total sample of 3687 physicians, 659 (18%) responded to the survey. One-third of the respondents had no experience with clinical ethics consultation, and 16% reported no access to consultation. General pediatricians were less likely to have access. The vast majority (90%) who had experience with consultation had found it helpful. Those with fewer years in practice were more likely to have training in ethics. The most frequently reported issues leading to consultation concerned end-of-life care and conflicts with patients/families or among the team. Intensive care unit physicians were more likely to have requested consultation. Mediation skills and ethics knowledge were the most highly valued consultant characteristics, and representing the official position of the hospital was the least-valued characteristic.

bsSec_4">Conclusion

bspara0025">There is variability in pediatricians' access to ethics consultation. Most respondents reported that consultation had been helpful in the past. Determining ethically appropriate end-of-life care and mediation of disagreements are common reasons that pediatricians request consultation.