Proactive Clinical Ethics Consultation, the Critically Ill
Conditions
Keywords
proactive clinical ethics consultation, critically ill, end-of-life care, interprofessional practicethe, interprofessional education
Brief summary
Study objective: This study is planning to explore factors predicting the use of life-sustaining treatment, develop the screening criteria of proactive clinical ethics consultations, the effect of proactive clinical ethics consultations and interprofessional practice on end-of-life care of the critically ill in the intensive care settings, and develop the competency for trainees by interprofessional education. Methods: Data will be collected prospectively. Data between January 2013 and April 2014 was collected from hospital electronic record and ethics consultation document. All data will be analyzed for patients dying in the intensive care settings during the first stage of the study. Factors predicting the use of life-sustaining treatment will be determined. The Delphi technique will be applied to secure a consensus among the panel of experts chosen to help develop the screening criteria of proactive ethics consultations. A prospective randomized controlled trial will be conducted during the second stage of the study on a convenience sample of adult critical ill patients in the intensive care settings. Patients will randomize to the intervention group receive proactive ethics consultations. The control group will undergo routine intensive care, receiving clinical ethics consultations as requested by healthcare team, patients or family. All participants will be asked to complete a questionnaire rating their satisfaction with the healthcare process and consultations if conducted. Mean length of stay and the duration of the use of life-sustaining treatment will be compared between two groups. Secondary outcomes will include the proportion of satisfied families and healthcare team members. The interprofessional education with the core curriculum and case scenario for simulation will be developed, implement, and evaluated.
Interventions
OTHERproactive clinical ethics consultation
When the patients meet the initiation criteria of this study, the patients were randomly assigned to the intervention group (providing proactive clinical ethics consultation) and the routine care group (no proactive clinical ethics consultation) after obtaining the consent of the subjects.
Sponsors
Kaohsiung Medical University Chung-Ho Memorial Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
1. Medical staff involved in caring for terminal patients 2. Cases of active clinical ethics consultation in our hospital
Exclusion criteria
1. Medical staff who refuse to participate in the study or are unable to understand the way the study is conducted 2. Cases of refusing to participate in the research or unable to understand the way the research is conducted.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| hospital length of stay | through study completion, an average of 2 years | days that patient in the hospital |
| ICU length of stay | through study completion, an average of 2 years | days that patient in the intensive care unit |
| use of life-sustaining treatment | through study completion, an average of 2 years | days of the use of life-sustaining treatment |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| family or surrogate satisfaction questionnaire | within 4 weeks after patient discharge | family or surrogate satisfaction for ethics consultation |
| healthcare provider satisfaction questionnaire | within 2 weeks after patient discharge | healthcare provider satisfaction for ethics consultation |
Countries
Taiwan
Outcome results
None listed