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Study objective: This study is planning to explore factors predicting the use of life-sustaining treatment, develop the screening criteria of proactive clinical ethics consultations, the effect of proactive clinical ethics consultations and interprofessional practice on end-of-life care of the critically ill in the intensive care settings, and develop the competency for trainees by interprofessional education.
Methods: Data will be collected prospectively. Data between January 2013 and April 2014 was collected from hospital electronic record and ethics consultation document. All data will be analyzed for patients dying in the intensive care settings during the first stage of the study. Factors predicting the use of life-sustaining treatment will be determined. The Delphi technique will be applied to secure a consensus among the panel of experts chosen to help develop the screening criteria of proactive ethics consultations. A prospective randomized controlled trial will be conducted during the second stage of the study on a convenience sample of adult critical ill patients in the intensive care settings. Patients will randomize to the intervention group receive proactive ethics consultations. The control group will undergo routine intensive care, receiving clinical ethics consultations as requested by healthcare team, patients or family. All participants will be asked to complete a questionnaire rating their satisfaction with the healthcare process and consultations if conducted. Mean length of stay and the duration of the use of life-sustaining treatment will be compared between two groups. Secondary outcomes will include the proportion of satisfied families and healthcare team members. The interprofessional education with the core curriculum and case scenario for simulation will be developed, implement, and evaluated.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| proactive clinical ethics consultation group | Experimental |
| |
| routine care group | No Intervention |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| proactive clinical ethics consultation | Other | When the patients meet the initiation criteria of this study, the patients were randomly assigned to the intervention group (providing proactive clinical ethics consultation) and the routine care group (no proactive clinical ethics consultation) after obtaining the consent of the subjects. |
| Measure | Description | Time Frame |
|---|---|---|
| hospital length of stay | days that patient in the hospital | through study completion, an average of 2 years |
| ICU length of stay | days that patient in the intensive care unit | through study completion, an average of 2 years |
| use of life-sustaining treatment | days of the use of life-sustaining treatment | through study completion, an average of 2 years |
| Measure | Description | Time Frame |
|---|---|---|
| family or surrogate satisfaction questionnaire | family or surrogate satisfaction for ethics consultation | within 4 weeks after patient discharge |
| family or surrogate satisfaction questionnaire |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Kaohsiung Medical University Chung-Ho hospital | Kaohsiung City | 807 | Taiwan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40753248 | Derived | Lin YK, Chen CW, Yeh YS, Lin CJ, Huang YW, Lin YC, Sheu CC. Impacts of mandatory clinical ethics consultation on resource utilization and ethical conflicts in critically ill patients: a comparison between medical and surgical intensive care units. BMC Med Ethics. 2025 Aug 2;26(1):110. doi: 10.1186/s12910-025-01268-4. |
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|
family or surrogate satisfaction for patient care
| within 4 weeks after patient discharge |
| healthcare provider satisfaction questionnaire | healthcare provider satisfaction for ethics consultation | within 2 weeks after patient discharge |
| ID | Term |
|---|---|
| D016638 | Critical Illness |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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