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Pediatric Ethics Consultation Services, Scope, and Staffing
Meaghann S Weaver1,2, Shiven Sharma3, Jennifer K Walter4,3
1Pediatric Palliative Care, University of Nebraska Medical Center, Omaha, Nebraska.
Insights
Pediatric ethics consultation services (PECS) show wide variation in staffing and funding. Many children
Area of Science:
- Pediatric healthcare ethics
- Clinical ethics consultation services
- Hospital administration and policy
Background:
- National guidelines emphasize the need for ethical conflict resolution in children's hospitals.
- The scope and structure of pediatric ethics consultation services (PECS) are not well-defined.
- Understanding current PECS practices is crucial for developing standardized approaches.
Purpose of the Study:
- To quantify the staffing, structure, function, scope, training, and funding of PECS in children's hospitals.
- To identify variations in PECS across different institutions.
- To assess the resources allocated to pediatric ethics support.
Main Methods:
- A cross-sectional online survey was distributed to ethics informants at 181 children's hospitals in the US.
- Data collection occurred between March and June 2022.
- Descriptive statistics and semantic content analyses were used to summarize survey responses.
Main Results:
- 104 children's hospitals completed the survey (65% response rate).
- Significant variation exists in PECS staffing (average 7.4 responsible individuals) and funding (median 0.25 FTE support, 33% with no salary support).
- Common consult themes include end-of-life care, treatment benefits/burdens, and staff moral distress; 21% of hospitals receive no patient/family consults.
Conclusions:
- Pediatric ethics consultation services exhibit considerable variability in their operational models and resource allocation.
- A significant lack of financial and institutional support for PECS is evident, despite considerable consultation volumes.
- These findings highlight a critical need for improved support and standardization of PECS to address ethical challenges in pediatric care.
Background And Objectives:
National standards and guidelines call for a mechanism to address ethical concerns and conflicts in children's hospitals. The roles, responsibilities, and reach of pediatric ethics consultation services (PECS) remain unmeasured. The purpose of this study is to quantify staffing, structure, function, scope, training, and funding of PECS.
Methods:
Cross-sectional online survey was shared with an ethics informant at 181 children's hospitals in the United States from March to June 2022. Data were summarized descriptively and with semantic content analyses.
Results:
One hundred seventeen surveys were received from individual children's hospitals in 45 states and Washington DC (response rate 65%), with 104 qualifying for survey completion. Almost one-quarter of settings received 50 or more pediatric ethics consults in the past 12 months. On average, 7.4 people at each institution have responsibility for completing ethics consults. Estimated full-time equivalent salary support for ethics is on average 0.5 (range 0-3, median 0.25). One-third (33%) of facilities do not offer any salary support for ethics and three-quarters do not have an institutional budget for the ethics program. Clinical staff primarily initiate consults. End-of-life, benefits versus burdens of treatments, and staff moral distress were the most frequently consulted themes. Almost one-quarter (21%) of children's hospitals do not receive any consults from patients or families.
Conlusions:
The findings from this study reveal wide variation in PECS practices and raise concern about the lack of financial support provided for PECS despite substantial workloads.
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