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

项目摘要/摘要 医疗保健干预和技术对一些人来说是适当的和改变生活的，显然是不道德的或 对其他人来说，生理上是徒劳的。介于这两个极端之间的不确定性是一种常见的 现代医疗保健伦理困境的根源。对于重症监护病房中约20%的患者来说， 干预可能会延长生命，但它们在急性护理环境之外提供的生存希望微乎其微。 这种情况称为潜在的不适当干预。这些情况是由多种因素造成的，例如 家庭需求，糟糕的团队合作，阻碍诚实讨论的等级制度，以及 倾向于采取激进的治疗方法。医疗保健提供者认识到这些情况对 忍受高科技、侵入性程序和治疗但没有取得有意义好处的患者 从他们那里。因此，医疗保健提供者觉得他们是不法行为的同谋--造成了不必要的 痛苦，长时间的死亡，以及不讲真话--也被称为精神痛苦。对…的干预 解决这种精神困扰的原因是一种伦理学咨询，称为道德痛苦咨询。这 卫生系统范围的干预旨在帮助经历精神痛苦的医疗保健提供者 找出原因并设计策略来补救原因。因此，这种干预旨在改善 通过对医疗保健提供者的精神痛苦采取行动来照顾病人。一次全国性的精神痛苦咨询 由来自全国各地的专家精神痛苦顾问组成的协作式，准备更全面地 描述繁重的干预和精神痛苦之间的联系，目的是帮助 临床医生和家属认识到并解决可能不适当干预的情况。因此， 这项研究的具体目标是1)生成与以下情况相关的障碍和策略的分类 通过协调和评估来自两个精神困扰的数据库来进行潜在的不适当干预 咨询服务，2)评估发挥作用的组织政策和州医疗保健法律 可能不适当的干预-特别关注与决策制定和代码相关的政策 地位，以及3)确定精神痛苦咨询的核心能力，以促进知识和专门知识 在国家精神痛苦咨询师中。

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.