Interfield agreement among intensive care unit medical directors and clinical ethics consultants concerning end-of-life decision making in Texas Medical Center

Abstract

Interfield agreement among intensive care unit medical directors and clinical ethics consultants concerning end-of-life decision making in Texas Medical Center Colleen M. Gallagher, Alina Bennett, Charles L. Sprung, Joseph L. Nates The University of Texas MD Anderson Cancer Center, Houston, TX, USA Hadassah Hebrew University Hospital, Israel Background/Purpose: To assess end-of-life (EOL) practice consensus between ethics consultants and medical directors in intensive care units (ICUs) within the 21 institutions in the Texas Medical Center (TMC). Methods: After institutional review board approval, we conducted a cross-sectional Web-based survey to assess a consensus estimate of interfield agreement among TMC ethics consultants and medical directors. Consensus was defined as greater than or equal to 80% agreement. Results: The study response rate was 55%. Fourteen survey items generated greater than 80% agreement. Greatest consensus (96%) was present in a number of key areas such as the impermissibility of age being used as the sole factor in determining EOL treatment options and timing of EOL discussions within 24 to 48 hours upon a patient's admission to the ICU. When patients are not expected to survive more than a few days, 90% of respondents agreed that it was appropriate to withdraw life support. In contrast, 14 questions revealed less than 79% consensus. No agreement was found in institutional practices; this illustrates the diversity of site-specific behavior. Respondents indicated that there is great variation in the utilization of formal meetings to determine EOL care decisions. The lowest agreement was about the integration of nurses in EOL decisions. Conclusions: Key areas of interfield agreement and disagreement exist among TMC ICU medical directors and ethics consultants in terms of decision making at the EOL. Future research can use the areas of greater and lower consensus to inform studies calibrated to finely assess the professional, environmental, and personal factors that contribute to the current EOL medical decision differences.