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

项目总结/文摘

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.