Identifying disincentives to ethics consultation requests among physicians, advance practice providers, and nurses: a quality improvement all staff survey at a tertiary academic medical center

Abstract Background Ethics consult services are well established, but often remain underutilized. Our aim was to identify the barriers and perceptions of the Ethics consult service for physicians, advance practice providers (APPs), and nurses at our urban academic medical center which might contribu...

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Main Authors: Lynette Cederquist, Jamie Nicole LaBuzetta, Edward Cachay, Lawrence Friedman, Cassia Yi, Laura Dibsie, Yiran Zhang
Format: Article
Language:English
Published: BMC 2021-04-01
Series:BMC Medical Ethics
Subjects:
Online Access:https://doi.org/10.1186/s12910-021-00613-7
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spelling doaj-1c478cba831149c58a821b7efe1d63062021-04-18T11:23:28ZengBMCBMC Medical Ethics1472-69392021-04-012211810.1186/s12910-021-00613-7Identifying disincentives to ethics consultation requests among physicians, advance practice providers, and nurses: a quality improvement all staff survey at a tertiary academic medical centerLynette Cederquist0Jamie Nicole LaBuzetta1Edward Cachay2Lawrence Friedman3Cassia Yi4Laura Dibsie5Yiran Zhang6Department of Medicine, Division of General Internal Medicine, University of California San DiegoDepartment of Neurosciences, University of California San DiegoDepartment of Medicine, Division of Infectious Diseases, University of California San DiegoDepartment of Medicine, Division of General Internal Medicine, University of California San DiegoDepartment of Nursing, University of California San DiegoDepartment of Nursing, University of California San DiegoDepartment of Family Medicine and Public Health, Division of Biostatistics and Bioinformatics, University of California San DiegoAbstract Background Ethics consult services are well established, but often remain underutilized. Our aim was to identify the barriers and perceptions of the Ethics consult service for physicians, advance practice providers (APPs), and nurses at our urban academic medical center which might contribute to underutilization. Methods This was a cross-sectional single-health system, anonymous written online survey, which was developed by the UCSD Health Clinical Ethics Committee and distributed by Survey Monkey. We compare responses between physicians, APPs, and nurses using standard parametric and non-parametric statistical methods. Satisfaction with ethics consult and likelihood of calling Ethics service again were assessed using a 0–100 scale using a 5-likert response structured (0 being “not helpful at all” to 100 being “extremely helpful”) and results presented using box plots and interquartile ranges (IQR). Results From January to July 2019, approximately 3800 surveys were sent to all physicians, APPs and nurses with a return rate of 5.5—10%. Although the majority of respondents had encountered an ethical dilemma (85–92.1%) only approximately half had ever requested an Ethics consult. The primary reason for physicians never having requested a consult was that they never felt the need for help (41%). For APPs the primary reasons were not knowing an Ethics consult service was available (33.3%) or not knowing how to contact Ethics (27.8%). For nurses, it was not knowing how to contact the Ethics consult service (30.8%) or not feeling the need for help (26.2%). The median satisfaction score (IQR) for Ethics consult services rated on a 0–100 scale, from physicians was 76 (29), for AAPs 89 (49), and nurses 70 (40) (p = 0.62). The median (IQR) of likelihood of consulting Ethics in the future also on a 0–100 scale was 71 (47) for physicians, 69 (45) for APPs, and 61 (45) for nurses (p = 0.79). APP’s and nurses were significantly more likely than physicians to believe that the team did not act on the Ethics consult’s recommendations. Conclusions Based on the results presented, we were able to identify actionable steps to better engage healthcare providers—and in particular APPs and nurses—and scale up institutional educational efforts to increase awareness of the role of the Ethics consult service at our institution. Actionable steps included implementing a system of ongoing feedback that is critical for the sustainability of the Ethics service role. We hope this project can serve as a blueprint for other hospital-based Ethics consult services to improve the quality of their programs.https://doi.org/10.1186/s12910-021-00613-7Ethics consultationStaff surveyBarriers
collection DOAJ
language English
format Article
sources DOAJ
author Lynette Cederquist
Jamie Nicole LaBuzetta
Edward Cachay
Lawrence Friedman
Cassia Yi
Laura Dibsie
Yiran Zhang
spellingShingle Lynette Cederquist
Jamie Nicole LaBuzetta
Edward Cachay
Lawrence Friedman
Cassia Yi
Laura Dibsie
Yiran Zhang
Identifying disincentives to ethics consultation requests among physicians, advance practice providers, and nurses: a quality improvement all staff survey at a tertiary academic medical center
BMC Medical Ethics
Ethics consultation
Staff survey
Barriers
author_facet Lynette Cederquist
Jamie Nicole LaBuzetta
Edward Cachay
Lawrence Friedman
Cassia Yi
Laura Dibsie
Yiran Zhang
author_sort Lynette Cederquist
title Identifying disincentives to ethics consultation requests among physicians, advance practice providers, and nurses: a quality improvement all staff survey at a tertiary academic medical center
title_short Identifying disincentives to ethics consultation requests among physicians, advance practice providers, and nurses: a quality improvement all staff survey at a tertiary academic medical center
title_full Identifying disincentives to ethics consultation requests among physicians, advance practice providers, and nurses: a quality improvement all staff survey at a tertiary academic medical center
title_fullStr Identifying disincentives to ethics consultation requests among physicians, advance practice providers, and nurses: a quality improvement all staff survey at a tertiary academic medical center
title_full_unstemmed Identifying disincentives to ethics consultation requests among physicians, advance practice providers, and nurses: a quality improvement all staff survey at a tertiary academic medical center
title_sort identifying disincentives to ethics consultation requests among physicians, advance practice providers, and nurses: a quality improvement all staff survey at a tertiary academic medical center
publisher BMC
series BMC Medical Ethics
issn 1472-6939
publishDate 2021-04-01
description Abstract Background Ethics consult services are well established, but often remain underutilized. Our aim was to identify the barriers and perceptions of the Ethics consult service for physicians, advance practice providers (APPs), and nurses at our urban academic medical center which might contribute to underutilization. Methods This was a cross-sectional single-health system, anonymous written online survey, which was developed by the UCSD Health Clinical Ethics Committee and distributed by Survey Monkey. We compare responses between physicians, APPs, and nurses using standard parametric and non-parametric statistical methods. Satisfaction with ethics consult and likelihood of calling Ethics service again were assessed using a 0–100 scale using a 5-likert response structured (0 being “not helpful at all” to 100 being “extremely helpful”) and results presented using box plots and interquartile ranges (IQR). Results From January to July 2019, approximately 3800 surveys were sent to all physicians, APPs and nurses with a return rate of 5.5—10%. Although the majority of respondents had encountered an ethical dilemma (85–92.1%) only approximately half had ever requested an Ethics consult. The primary reason for physicians never having requested a consult was that they never felt the need for help (41%). For APPs the primary reasons were not knowing an Ethics consult service was available (33.3%) or not knowing how to contact Ethics (27.8%). For nurses, it was not knowing how to contact the Ethics consult service (30.8%) or not feeling the need for help (26.2%). The median satisfaction score (IQR) for Ethics consult services rated on a 0–100 scale, from physicians was 76 (29), for AAPs 89 (49), and nurses 70 (40) (p = 0.62). The median (IQR) of likelihood of consulting Ethics in the future also on a 0–100 scale was 71 (47) for physicians, 69 (45) for APPs, and 61 (45) for nurses (p = 0.79). APP’s and nurses were significantly more likely than physicians to believe that the team did not act on the Ethics consult’s recommendations. Conclusions Based on the results presented, we were able to identify actionable steps to better engage healthcare providers—and in particular APPs and nurses—and scale up institutional educational efforts to increase awareness of the role of the Ethics consult service at our institution. Actionable steps included implementing a system of ongoing feedback that is critical for the sustainability of the Ethics service role. We hope this project can serve as a blueprint for other hospital-based Ethics consult services to improve the quality of their programs.
topic Ethics consultation
Staff survey
Barriers
url https://doi.org/10.1186/s12910-021-00613-7
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