Ethics Consultations have been introduced into the practice of medicine during the past twenty years as a way to help physicians, patients and families come to a decision about medical treatment where value conflicts are involved. GOAL OF RESEARCH: To test the hypothesis that ethics consultations improve the process and outcomes of patient care by helping to identify, analyze and resolve ethical problems.
SPECIFIC AIMS : To carry out a prospective control v. intervention trial of ethics consultations in the intensive care setting and assess their impact on patient care. OUTCOME MEASURES: Quantitative data from medical records, in particular CPR events, DNAR orders, artificial feeding days, hours on a ventilator, days in the hospital, days in the ICU, mortality, and estimated medical charges. Qualitative data from physician, patient, and family member interviews such as whether the consultation was perceived as being helpful in identifying, analyzing and resolving ethical issues, whether it was stressful, informative, supportive, as well as assisting with communication. RESEARCH DESIGN: Prospective, randomized control v. intervention trial of ethics consultations. METHODOLOGY: Subjects will be recruited from the UCSDMC Medical, Surgical, Burn, and Pediatric Intensive care units. The subjects will constitute 100 patients in whom value-based treatment conflicts are noted by assigned nurses. The nurse will report the patient's medical record to the office of the ethics consultation. According to a prior established random strategy, the patient will be assigned to the intervention or nonintervention arm of the trial. If the patient is in the nonintervention arm of the trial, the Principal Investigator (PI) will not initiate contact with the healthcare team. If the patient is in the intervention arm of the trial, the PI will contact the responsible physician and offer to have the ethics consult team conduct an ethics consultation as deemed most appropriate for the issues under consideration. After approximately 50 consultations and 50 control patients have been accumulated, the data will be collected by an independent chart reviewer and interviewer. Quantitative and qualitative data will be analyzed in accordance with appropriate statistical methodology. SIGNIFICANCE: This study represents a pilot approach to the evaluation of the impact of ethics consultation on patient care that is unique and unprecedented, yet generalizable to other medical centers.
