Ethics Consultations at a Major Academic Medical Center: A Retrospective, Longitudinal Analysis

Area of Science:

• Medical Ethics
• Healthcare Management
• Clinical Practice

Background:

• Healthcare professionals often lack adequate training to manage ethical dilemmas, leading to stress.
• Clinical ethics consultation and preventive ethics strategies may reduce this stress, but specific concerns require further investigation.

Purpose of the Study:

• To analyze a database of ethics consultations to identify major sources of ethical concern.
• To evaluate changes in the content and frequency of these concerns over time.
• To examine trends in ethics consultation requests initiated by nurses versus physicians.

Main Methods:

• Retrospective, longitudinal analysis of ethics consultation data from a major academic medical center.
• Categorization of consultation requests into six key themes: Conflict Over Goals of Care, Decisional Capacity, Withholding/Withdrawing Treatment, Proxy Decision Making, Communication, and Behavior.
• Statistical analysis to identify trends and differences between nurse and physician-initiated requests.

Main Results:

• Key ethical concerns identified include Conflict Over Goals of Care, Decisional Capacity, Withholding/Withdrawing Treatment, Proxy Decision Making, Communication, and Behavior.
• Significant increases were observed in requests related to Conflict Over Goals of Care and Discharge Planning.
• Nurses were more likely to request consultations for Communication issues, while physicians were more likely to request them for Proxy Decision-Making and Decisional Capacity.

Conclusions:

• The study highlights distinct trends and sources of ethical concern between nurses and physicians.
• Identified trends in ethics consultation requests can inform the development of future preventive ethics frameworks.
• Understanding these differences is crucial for targeted interventions to support healthcare professionals facing ethical challenges.