Clinical ethics consultations in the ICU are associated with helpful, though stressful, experiences and greater consensus among surrogates and clinicians, as well as shorter ICU length of stay, a recent systematic review and meta-analysis found.
Researchers reviewed 16 studies published from 1988 to 2015 that assessed outcomes after clinical ethics consultations took place in the ICU. Eight of the included studies were retrospective cohort studies and had low risk of bias, and seven studies were randomized controlled trials or prospective controlled cohorts, none of which had low risk of bias (largely because none blinded participants).Twelve (80%) of the studies were conducted in the U.S. Settings included medical, surgical, medical-surgical, trauma, oncologic, and cardiothoracic surgery ICUs.
Primary outcomes were user satisfaction or experience, resolution of conflict, and ability to make a clinical decision. Resource utilization (e.g., ICU length of stay) was a secondary outcome. Results were published online on Feb. 1 by Critical Care Medicine.
Ethics consultations in the ICU were associated with a positive user experience (106 of 116 surrogates/patients and 283 of 319 clinicians found them helpful), although 113 of 431 family members and clinicians found them stressful. Among 194 clinical decision-making events in three studies, consensus was more frequently achieved with a consultation than without (odds ratio, 4.09; 95% CI, 1.01 to 16.55; P=0.05). In addition, ethics consultation was associated with lower resource utilization, including significantly decreased length of stay in the ICU for both surviving and nonsurviving patients (mean difference, −7.13 days; 95% CI, −11.24 to −3.03 days; P=0.007)
The authors noted limitations of their review, such as a limited sample, a lack of generalizability to non-ICU populations, and heterogeneity between studies. They added that the outcomes measured in the studies are limited and that future studies should use more specific process measures (e.g., a “Quality of Communication Index”) to assess the quality of ethics consultations.