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Principal Investigator: Donald E Brown
Organization: UNIVERSITY OF VIRGINIA
Fiscal Year: 2021
Award: $169,903
Funding agency: National Center for Advancing Translational Sciences
Project Summary/Abstract
Healthcare interventions and technologies are appropriate and life-changing for some and clearly unethical or
physiologically futile for others. The band of uncertainty that lies between these two extremes is a common
source of ethical dilemmas in modern healthcare. For about 20% of patients in intensive care units,
interventions may be life-prolonging but they offer little hope of survival outside the acute care setting—a
situation called potentially inappropriate intervention. These situations arise due to multiple factors such as
family demands, poor team collaboration, hierarchies that inhibit honest discussion, and societal norms that
tend to default to aggressive treatments. Healthcare providers recognize these situations as burdensome for
patients who endure high-tech, invasive procedures and treatments but who do not achieve meaningful benefit
from them. As a result, healthcare providers feel they are complicit in wrongdoing--causing unnecessary
suffering, prolonged dying, and lack of truth-telling—otherwise known as moral distress. An intervention to
address this cause of moral distress is a type of ethics consultation called moral distress consultation. This
health system-wide intervention is designed to assist healthcare providers experiencing moral distress to
identify the causes and to design strategies to remedy the causes. Thus, this intervention seeks to improve
patient care by acting on healthcare provider moral distress. A national Moral Distress Consultation
Collaborative, composed of expert moral distress consultants from across the country is poised to more fully
characterize the connection between burdensome interventions and moral distress with the goal of helping
clinicians and families recognize and resolve situations of potentially inappropriate intervention. Consequently,
the specific aims of this study are to 1) generate a taxonomy of barriers and strategies relevant to situations of
potentially inappropriate intervention by harmonizing and evaluating a database from two moral distress
consultation services, 2) evaluate organizational policies and state healthcare laws that play a role in
potentially inappropriate interventions—specifically focusing on policies related to decision making and code
status, and 3) define core competencies for moral distress consultation to promote knowledge and expertise
among the nations moral distress consultants.
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