P0576 - Attitudes and Utilization of Ethics Consults among All Pediatric Medical Team Members

Background: Studies have shown that across hospitals, pediatric ethics committees are underutilized. Ethics consults are initiated about once per month or less, despite there being a variety of ethically-challenging situations in Pediatrics. There exist studies on why attending physicians and residents may not utilize ethics committees. However, these studies are relatively few, and there is less literature on the role of other members of the care team in calling pediatrics ethics consults. This study seeks to examine the perceptions of the ethics committee by a wider group of disciplines within the care team and the barriers that exist for them in the process of deciding to call a consult.

Methods: A survey was sent out to attending physicians, fellows, house staff, nursing, and CLS at a medium-sized children’s hospital to compare participation in ethics consults and knowledge of how to utilize ethics consults. Then, focus groups were held to obtain more detailed qualitative information. The focus groups were transcribed and coded to identify major themes.

Results: At this hospital, any care team member can initiate an ethics consultation. However, attending physicians were significantly more likely to know how to call an ethics consult and to have called an ethics consult than all other groups (Table 1). They were also significantly more likely to have been part of a consult than house staff, and more likely to know an ethics committee member than nurses or CLS (Table 1). All groups were largely similar in their reasons for calling consults and scenarios in which they would call a consult, although attending physicians were overall slightly less likely to want an ethics consult. Focus group analysis revealed that consults may be called infrequently and after delay because attending physicians have a high threshold for calling ethics consults without an emotional demand by other team members. Groups also suggested that while nursing and CLS feel the most moral distress due to their proximity with patients and families, they are less able to access the ethics committee due to procedural limitations and hierarchical team dynamics.

Conclusions: Ethics consults are often called to resolve ethical conflicts, facilitate communication, and ease moral distress in patient care. Attending physicians often take the lead in calling these consults and are the best-educated on the process of an ethics consult. However, given that other team members are as much, if not more, aware of ethical dilemmas as they develop, and may engage more directly with daily patient care, non-attending team members should be encouraged to initiate consults when necessary. This may be achieved by increasing efforts by the ethics committee to acquaint all care providers with ethics committee members and the consult process to normalize calling consults.