The integrated Translational Health Research Institute of Virginia (iTHRIV): Using Data to Improve Health

项目总结/摘要 医疗保健干预措施和技术是适当的，改变了一些人的生活，显然是不道德的， 生理上对其他人无效。介于这两个极端之间的不确定性是一个共同的问题。 现代医疗中伦理困境的根源。对于重症监护病房中约20%的患者， 干预措施可能延长生命，但它们在急性护理环境之外几乎没有生存的希望， 这种情况称为潜在的不适当干预。这些情况的出现是由于多种因素，如 家庭要求，糟糕的团队合作，阻碍诚实讨论的等级制度，以及 倾向于采取积极的治疗。医疗保健提供者认识到这些情况是负担， 忍受高科技、侵入性手术和治疗但未获得有意义获益的患者 远离他们因此，医疗保健提供者认为他们是不法行为的同谋-造成不必要的 痛苦，长期死亡，缺乏说实话-否则被称为道德困扰。干预， 解决这种道德困扰的原因是一种伦理咨询，称为道德困扰咨询。这 卫生系统范围的干预旨在帮助经历道德困境的医疗保健提供者， 找出原因，并制定战略，以纠正这些原因。因此，这一干预措施旨在改善 通过对医疗保健提供者的道德困扰采取行动来照顾病人。全国道德困境咨询 协作，由来自全国各地的专家道德困扰顾问组成，准备更充分地 描述繁重的干预和道德困扰之间的联系，以帮助 临床医生和家庭认识到并解决可能不适当干预的情况。因此，委员会认为， 本研究的具体目标是：1）生成与以下情况相关的障碍和策略分类： 通过协调和评估来自两个道德困境的数据库， 咨询服务，2）评估组织政策和国家卫生保健法律，发挥作用， 潜在的不适当干预-特别是关注与决策制定和代码相关的策略 地位，以及3）确定道德困境咨询的核心能力，以促进知识和专业知识 在国家的道德困扰顾问中。

Project Summary/Abstract Healthcare interventions and technologies are appropriate and life-changing for some and clearly unethical or physiologically futile for others. The band of uncertainty that lies between these two extremes is a common source of ethical dilemmas in modern healthcare. For about 20% of patients in intensive care units, interventions may be life-prolonging but they offer little hope of survival outside the acute care setting—a situation called potentially inappropriate intervention. These situations arise due to multiple factors such as family demands, poor team collaboration, hierarchies that inhibit honest discussion, and societal norms that tend to default to aggressive treatments. Healthcare providers recognize these situations as burdensome for patients who endure high-tech, invasive procedures and treatments but who do not achieve meaningful benefit from them. As a result, healthcare providers feel they are complicit in wrongdoing--causing unnecessary suffering, prolonged dying, and lack of truth-telling—otherwise known as moral distress. An intervention to address this cause of moral distress is a type of ethics consultation called moral distress consultation. This health system-wide intervention is designed to assist healthcare providers experiencing moral distress to identify the causes and to design strategies to remedy the causes. Thus, this intervention seeks to improve patient care by acting on healthcare provider moral distress. A national Moral Distress Consultation Collaborative, composed of expert moral distress consultants from across the country is poised to more fully characterize the connection between burdensome interventions and moral distress with the goal of helping clinicians and families recognize and resolve situations of potentially inappropriate intervention. Consequently, the specific aims of this study are to 1) generate a taxonomy of barriers and strategies relevant to situations of potentially inappropriate intervention by harmonizing and evaluating a database from two moral distress consultation services, 2) evaluate organizational policies and state healthcare laws that play a role in potentially inappropriate interventions—specifically focusing on policies related to decision making and code status, and 3) define core competencies for moral distress consultation to promote knowledge and expertise among the nations moral distress consultants.