The Effect of Proactive Clinical Ethics Consultations on End-of-life Care of the Critically Ill in the Intensive Care Settings

Study Overview
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Brief Summary
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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.

Conditions
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Proactive Clinical Ethics Consultation, the Critically Ill

Intervention / Treatment
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* Other: proactive clinical ethics consultation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Medical staff involved in caring for terminal patients Cases of active clinical ethics consultation in our hospital Exclusion Criteria: Medical staff who refuse to participate in the study or are unable to understand the way the study is conducted Cases of refusing to participate in the research or unable to understand the way the research is conducted.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: proactive clinical ethics consultation group<br> | Other: proactive clinical ethics consultation<br>* 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.<br>|
| No Intervention: routine care group<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| hospital length of stay | days that patient in the hospital | through study completion, an average of 2 years | 
| ICU length of stay | days that patient in the intensive care unit | through study completion, an average of 2 years | 
| use of life-sustaining treatment | days of the use of life-sustaining treatment | through study completion, an average of 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| family or surrogate satisfaction questionnaire | family or surrogate satisfaction for ethics consultation | within 4 weeks after patient discharge | 
| family or surrogate satisfaction questionnaire | family or surrogate satisfaction for patient care | within 4 weeks after patient discharge | 
| healthcare provider satisfaction questionnaire | healthcare provider satisfaction for ethics consultation | within 2 weeks after patient discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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proactive clinical ethics consultation, critically ill, end-of-life care, interprofessional practicethe, interprofessional education