Morrison Wynne, Womer James, Nathanson Pamela, Kersun Leslie, Hester D Micah, Walsh Corbett, Feudtner Chris
Pediatric Advanced Care Team, Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Pediatric Advanced Care Team, Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, PA; Temple University School of Medicine, Philadelphia, PA.
J Pediatr. 2015 Oct;167(4):919-924.e1. doi: 10.1016/j.jpeds.2015.06.047. Epub 2015 Jul 23.
To conduct a national survey of pediatricians' access to and experience with clinical ethics consultation.
We surveyed a randomly selected sample of 3687 physician members of the American Academy of Pediatrics. We asked about their experiences with ethics consultation, the helpfulness of and barriers to consultation, and ethics education. Using a discrete choice experiment with maximum difference scaling, we evaluated which traits of ethics consultants were most valuable.
Of the total sample of 3687 physicians, 659 (18%) responded to the survey. One-third of the respondents had no experience with clinical ethics consultation, and 16% reported no access to consultation. General pediatricians were less likely to have access. The vast majority (90%) who had experience with consultation had found it helpful. Those with fewer years in practice were more likely to have training in ethics. The most frequently reported issues leading to consultation concerned end-of-life care and conflicts with patients/families or among the team. Intensive care unit physicians were more likely to have requested consultation. Mediation skills and ethics knowledge were the most highly valued consultant characteristics, and representing the official position of the hospital was the least-valued characteristic.
There is variability in pediatricians' access to ethics consultation. Most respondents reported that consultation had been helpful in the past. Determining ethically appropriate end-of-life care and mediation of disagreements are common reasons that pediatricians request consultation.
开展一项关于儿科医生获得临床伦理咨询服务及相关经历的全国性调查。
我们对美国儿科学会随机抽取的3687名医生会员进行了调查。我们询问了他们在伦理咨询方面的经历、咨询的帮助程度和障碍以及伦理教育情况。通过使用具有最大差异缩放的离散选择实验，我们评估了伦理咨询师的哪些特质最有价值。
在3687名医生的总样本中，659名（18%）回复了调查。三分之一的受访者没有临床伦理咨询经验，16%的受访者表示无法获得咨询服务。普通儿科医生获得咨询服务的可能性较小。绝大多数（90%）有咨询经验的受访者认为咨询很有帮助。从业年限较少的医生更有可能接受过伦理培训。导致咨询的最常见问题涉及临终关怀以及与患者/家属或团队之间的冲突。重症监护室医生更有可能请求咨询。调解技能和伦理知识是最受重视的咨询师特质，而代表医院的官方立场是最不受重视的特质。
儿科医生获得伦理咨询服务的情况存在差异。大多数受访者表示过去咨询很有帮助。确定符合伦理的临终关怀以及调解分歧是儿科医生请求咨询的常见原因。
