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Correspondence |

Palliative Care, Spiritual Care, and Clinical Ethics: Widely Available, but Underused FREE TO VIEW

Scott Howard Snyder, MD; Nneka Sederstrom, PhD, FCCP; J. Keith Mansel, MD, FCCP; Hunter Groninger, MD
Author and Funding Information

This work was presented as a poster at the 2016 International Conference on Clinical Ethics Consultation, May 2016, in Washington, DC.

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aDivision of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD

bClinical Ethics Department, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN

cUniversity of Mississippi Medical Center, Jackson, MS

dPalliative Care, MedStar Washington Hospital Center, Washington, DC

CORRESPONDENCE TO: Scott Howard Snyder, MD, Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, 5200 Eastern Ave, MFL-C, 2nd Floor, Ste 2200, Baltimore, MD 21224


Copyright 2017, . All Rights Reserved.


Chest. 2017;151(6):1404-1406. doi:10.1016/j.chest.2017.03.034
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With expansion of hospital-based care come increasingly complex needs inviting palliative care (PC), clinical ethics (CE), and spiritual care (SC) collaboration. Commonly encountered situations include withdrawal of life-sustaining therapies, surrogate decision-making, provider conflict, and spiritual/religious distress, all of which overlap among PC, CE, and SC domains of expertise. Nevertheless, although hospitals commonly use these three clinical services, little guidance exists regarding which service to consult, how they might best collaborate, and their effect on quality benchmarks.,,,

To learn more about consultation preferences in critical care settings, we conducted an institutional review board–approved 22-question online survey to members of the American College of Chest Physicians in August 2015. The survey presented three cases in critical care settings and elicited responses regarding consultation needs preferences.

The survey yielded 72 responses (6% response rate, 100% completion rate). Respondents (88% physicians, 83% intensivists, 63% male) reported high availability of PC (81%), CE (74%), and SC (79%) at their institutions. Despite high availability of all these services, only 14% of respondents reported “routinely” or “often” consulting CE, compared with 72% for PC and 63% for SC. In hypothetical cases, most respondents expressed preference to consult PC for a patient with stage IV lung cancer admitted to their ICU for hypoxemic respiratory failure (case 1) or for a patient with an estimated prognosis of weeks who wants “everything done” (case 2) (Fig 1). For a mechanically ventilated patient with multisystem organ failure and no available surrogate decision-maker, 40.3% of respondents would consult CE first (case 3), compared with 25% for PC and 5.6% for SC (P < .05). No association was found between responses and clinician age or sex.

Figure Jump LinkFigure 1 Survey responses to hypothetical ICU cases followed by the question, “Which consultant would you contact first?”Grahic Jump Location

Provider preference for PC over CE or SC is notable, despite high availability of all three services. Lower rates of SC consultation may reflect that PC teams frequently engage chaplain services themselves, that chaplains visit patients without specific requests, or that clinicians limit SC involvement to end-of-life rituals. Lower preference for CE may indicate less bedside CE consult availability or respondents’ belief that they can handle ethical issues alone. Low response rate may reflect survey fatigue but respondents are likely invested in engaging PC, CE, and/or SC.

How and when we invite and assimilate experts in supportive care to the critical care setting affects patient and family experience. Future research should further investigate relationships among critical care providers and PC, SC, and CE consultants.

References

Morrison W. .Derrington S.F. . Stories and the longitudinal patient relationship: what can clinical ethics consultants learn from palliative care? J Clin Ethics. 2012;23:224-230 [PubMed]journal. [PubMed]
 
Maung A.A. .Toevs C.C. .Kayser J.B. .Kaplan L.J. . Conflict management teams in the intensive care unit: a concise definitive review. J Trauma Acute Care Surg. 2015;79:314-320 [PubMed]journal. [CrossRef] [PubMed]
 
Carter B.S. .Wocial L.D. . Ethics and palliative care: which consultant and when? Am J Hosp Palliat Care. 2012;29:146-150 [PubMed]journal. [CrossRef] [PubMed]
 
Aulisio M.P. .Chaitin E. .Arnold R.M. . Ethics and palliative care consultation in the intensive care unit. Crit Care Clin. 2004;20:505-523 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1 Survey responses to hypothetical ICU cases followed by the question, “Which consultant would you contact first?”Grahic Jump Location

Tables

References

Morrison W. .Derrington S.F. . Stories and the longitudinal patient relationship: what can clinical ethics consultants learn from palliative care? J Clin Ethics. 2012;23:224-230 [PubMed]journal. [PubMed]
 
Maung A.A. .Toevs C.C. .Kayser J.B. .Kaplan L.J. . Conflict management teams in the intensive care unit: a concise definitive review. J Trauma Acute Care Surg. 2015;79:314-320 [PubMed]journal. [CrossRef] [PubMed]
 
Carter B.S. .Wocial L.D. . Ethics and palliative care: which consultant and when? Am J Hosp Palliat Care. 2012;29:146-150 [PubMed]journal. [CrossRef] [PubMed]
 
Aulisio M.P. .Chaitin E. .Arnold R.M. . Ethics and palliative care consultation in the intensive care unit. Crit Care Clin. 2004;20:505-523 [PubMed]journal. [CrossRef] [PubMed]
 
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