PMID- 24387594
OWN - NLM
STAT- MEDLINE
DCOM- 20141104
LR  - 20221129
IS  - 1472-6939 (Electronic)
IS  - 1472-6939 (Linking)
VI  - 15
DP  - 2014 Jan 3
TI  - To evaluate the effectiveness of health care ethics consultation based on the 
      goals of health care ethics consultation: a prospective cohort study with 
      randomization.
PG  - 1
LID - 10.1186/1472-6939-15-1 [doi]
AB  - BACKGROUND: The growing prevalence of health care ethics consultation (HCEC) 
      services in the U.S. has been accompanied by an increase in calls for 
      accountability and quality assurance, and for the debates surrounding why and how 
      HCEC is evaluated. The objective of this study was to evaluate the effectiveness 
      of HCEC as indicated by several novel outcome measurements in East Asian medical 
      encounters. METHODS: Patients with medical uncertainty or conflict regarding 
      value-laden issues, and requests made by the attending physicians or nurses for 
      HCEC from December 1, 2009 to April 30, 2012 were randomly assigned to the usual 
      care group (UC group) and the intervention group (HCEC group). The patients in 
      the HCEC group received HCEC conducted by an individual ethics consultant. Data 
      analysis was based on the intention-to-treat principle. Mann-Whitney test and 
      Chi-squared test were used depending on the scale of measurement. RESULTS: 
      Thirty-three patients (53.23%) were randomly assigned to the HCEC group and 29 
      patients were randomly assigned to the UC group. Among the 33 patients in the 
      HCEC group, two (6.06%) of them ultimately did not receive a HCEC service. Among 
      the 29 patients in the UC group, four (13.79%) of them received a HCEC service. 
      The survival rate at hospital discharge did not differ between the two groups. 
      Patients in the HCEC group showed significant reductions in the entire ICU stay 
      and entire hospital stay. HCEC significantly facilitated achieving the goal of 
      medical care (p < .01). Furthermore, patients in the HCEC group had a shorter ICU 
      stay and shorter hospital stay after the occurrence of medical uncertainty or 
      conflict regarding value-laden issues than those in the UC group. CONCLUSIONS: 
      Our findings demonstrated that HCEC were associated with reduced consumption of 
      medical resources as indicated by shorter entire ICU stay, entire hospital stay, 
      and shorter ICU and hospital stay after the occurrence of the medical uncertainty 
      or conflict regarding value-laden issues. This study also showed that HCEC 
      facilitated achieving a consensus regarding the goal of medical care, which 
      conforms to the goal of HCEC.
FAU - Chen, Yen-Yuan
AU  - Chen YY
FAU - Chu, Tzong-Shinn
AU  - Chu TS
FAU - Kao, Yu-Hui
AU  - Kao YH
FAU - Tsai, Pi-Ru
AU  - Tsai PR
FAU - Huang, Tien-Shang
AU  - Huang TS
AD  - Department of Social Medicine, National Taiwan University College of Medicine, 
      Taipei, Taiwan. huangts@ntu.edu.tw.
FAU - Ko, Wen-Je
AU  - Ko WJ
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20140103
PL  - England
TA  - BMC Med Ethics
JT  - BMC medical ethics
JID - 101088680
SB  - IM
MH  - Bioethics
MH  - *Conflict, Psychological
MH  - Critical Care/*ethics
MH  - *Ethics Committees/standards
MH  - *Ethics Consultation/standards
MH  - Female
MH  - Humans
MH  - Intensive Care Units/ethics
MH  - Length of Stay/*statistics & numerical data
MH  - Male
MH  - Medical Futility/*ethics
MH  - Outcome Assessment, Health Care
MH  - Patient Care Team
MH  - Physician-Patient Relations/ethics
MH  - Program Evaluation
MH  - Prospective Studies
MH  - Quality Assurance, Health Care
MH  - Taiwan
MH  - United States
PMC - PMC3898237
EDAT- 2014/01/07 06:00
MHDA- 2014/11/05 06:00
PMCR- 2014/01/03
CRDT- 2014/01/07 06:00
PHST- 2013/08/16 00:00 [received]
PHST- 2013/12/30 00:00 [accepted]
PHST- 2014/01/07 06:00 [entrez]
PHST- 2014/01/07 06:00 [pubmed]
PHST- 2014/11/05 06:00 [medline]
PHST- 2014/01/03 00:00 [pmc-release]
AID - 1472-6939-15-1 [pii]
AID - 10.1186/1472-6939-15-1 [doi]
PST - epublish
SO  - BMC Med Ethics. 2014 Jan 3;15:1. doi: 10.1186/1472-6939-15-1.