Embargoed by the Journal of the American Medical Association for 4 p.m. EDT Tuesday, Sept. 2, 2003
UCSD Team Finds that Ethics Consultations Reduce Futile End-of-Life Treatments
Researchers at the University of California, San Diego (UCSD) School of Medicine found a significant reduction in non-beneficial life sustaining treatments for dying patients in hospital intensive care units (ICUs), when health care providers and family members were provided with ethics counseling.
Published in the Sept. 3, 2003 issue of the Journal of the American Medical Association, the study also found that 87 percent of patients, their families, physicians and nurses, considered the counseling to be very helpful in solving treatment conflicts.
“This means that patients at the end of life endure less suffering caused by treatments that ultimately prove to be futile,” said the study’s senior author, Lawrence J. Schneiderman, M.D., a UCSD professor in the Departments of Medicine and Family and Preventive Medicine. “Instead, patients are likely to receive the kind of comfort care that assures a good death.”
While the Joint Commission on the Accreditation of Health Care Organizations requires hospitals to provide ethics consultation services, “not all hospitals have devoted enough attention and resources to assure the high quality of this intervention,” Schneiderman said. “This study is the first evidence-based proof of this intervention’s efficacy.”
Noting that 60 percent of Americans die in an acute care hospital, Schneiderman said that physicians and nurses strongly influence the manner of dying. “Very often, treatment decisions have to be made that are fraught with emotion and conflict. What these findings demonstrate is that a skilled ethics consultation service can help physicians, nurses, patients and family members deal with the conflicts and reduce non-beneficial, life-prolonging treatments.”
The study was carried out between November 2000 and December 2002 with 551 patients in whom value-related treatment conflicts arose during the course of treatment in seven U.S. hospitals. Patients, their families and healthcare providers were randomly assigned either to an ethics consultation or no consultation.
The researchers found no difference in overall mortality between the patients who received counseling and those who did not. Those counseled, however, spent three fewer days in the hospital and nearly 1.5 fewer days in ICUs, as well as two fewer days receiving life-sustaining treatments, such as mechanical ventilation.
These results confirmed an earlier randomized, controlled trial conducted at UCSD, which also found a striking reduction in non-beneficial life sustaining treatments. These earlier results encouraged the Agency for Healthcare Research and Quality to fund the larger seven-hospital study.
Hospitals participating in the study were Montefiore Medical Center/Weiler Division (a teaching hospital for Albert Einstein Medical School), New York City; Hennepin County Medical Center (a public teaching hospital affiliated with the University of Minnesota Medical School), Minneapolis, Minn.; Swedish Covenant Hospital (a community hospital), Chicago, Illinois; Little Company of Mary Hospital (a general acute care community hospital), Torrance, California; Stanford Medical Center (the teaching hospital for Stanford Medical School), Stanford, California; University of California, Irvine Medical Center, Irvine, California; Southern California Permanente Medical Group (a major hospital in the Kaiser Health Maintenance Organization), San Diego, California.
In addition to Schneiderman, authors of the paper were Todd Gilmer, Ph.D. and Holly D. Teetzel, M.A., UCSD Department of Family and Preventive Medicine; Daniel Dugan, Ph.D., Ethics Department, Swedish Covenant Hospital; Jeffrey Blustein, Ph.D., Department of Epidemiology and Social Medicine, Montefiore Medical Center; Ronald Cranford, M.D., Department of Neurology, and Kathleen B. Briggs, M.A., LICSW, Department of Social Services, Hennepin County Medical Center; Glen I. Komatsu, M.D., Neonatology and Bioethics/ICU, Little Company of Mary Hospital; Paula Goodman-Crews, MSW, LCSW, Bioethics Consultant, Quality Resource Management, Kaiser Permanente San Diego; Felicia Cohn, Ph.D., Department of Medicine, UC Irvine; and Ernle W. D. Young, Ph.D., Center for Biomedical Ethics, Stanford University School of Medicine.
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