Communication and Conflict Management Training for Clinical Bioethics Committees
Johns Hopkins Medicine's Howard County General Hospital, 5755 Cedar Lane, Columbia, MD 21044, USA. HEC Forum
10/2009; 21(4):341-9. DOI: 10.1007/s10730-009-9116-7
Available from: Carol Pavlish
- "The public's expectations of medical cure; a swing over the last 20 years toward patient autonomy in medical decision making; a society that is multicultural with diverse religious traditions; continued medical advances, and policies and guidelines that do not keep pace with the challenging developments; and shifts in health care financing can all lead to ethical conflicts (Azoulay et al. 2009; Curtis and Vincent 2010; Frost et al. 2011; Levin et al. 2010; Luce and White 2007; Morris and Dracup 2008). Ethical conflicts often emerge " when patients, surrogates , or clinicians perceive that their goals related to care and outcomes are being thwarted by the incompatible goals of others " (Edelstein et al. 2009, 342). These differences can quickly flame into disruptive arguments and behaviors (Agich 2011). "
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ABSTRACT: Background: Limited information on risk factors for ethically difficult clinical situations exists. Identifying common factors in these situations could encourage a more proactive, system-wide approach to ethical issues, which could mitigate patient and family suffering, providers’ moral stress, and costly ethical conflicts. Methods: Quantitative and qualitative data analyses were performed on physician responses to an online survey that queried physician perceptions about ethically complex situations in a large academic medical center and community hospital. Results: Representing 30 specialties, 114 physicians responded. The most frequently encountered situation was working with patients who lacked capacity for decision making. End-of-life treatment decisions and family adamancy were ranked as the most intense situations. Interactional risk factors such as different moral perspectives and poor communication were most prominent (53.9%); patient and family risk factors were also described (33%). Physicians identified early and frequent communication with seriously ill patients and their families as the primary protection against ethical conflict. Ethics skill-building, good teamwork, and creating an ethics-minded culture were also featured as important preventive measures. Pressure from others to take morally uncomfortable action was most often cited as a source of moral stress. The pressure of limited time to address ethical issues was also frequently mentioned. These pressures could progress to ethical conflicts, which often compounded moral stress. A majority of physicians reported willingness to work with nurses on ethically difficult situations. Conclusions: Physicians are very aware of ethical complexities in their clinical practice and take their moral responsibilities very seriously. Communicating effectively with patients, families, and other health care team members and advocating for adequate resources, including ethics resources, are important avenues to mitigate ethical conflicts.
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ABSTRACT: PURPOSE OF REVIEW: Conflicts occur frequently in the ICU. Research on ICU conflicts is an emerging field, with only few recent studies being available on intrateam and team-family conflicts. Research on communication in the ICU is developing at a faster pace. RECENT FINDINGS: Recent findings come from one multinational epidemiological survey on intrateam conflicts and one qualitative study on the causes and consequences of conflicts. Advances in research on communication with families in the ICU have improved our understanding of team-family and intrateam conflicts, thus suggesting targets for improvement. SUMMARY: Data about ICU conflicts depend on conflict definition, study designs (qualitative versus quantitative), patient case-mix, and detection bias. Conflicts perceived by caregivers are frequent and consist mainly in intrateam conflicts. The two main sources of conflicts in the ICU are end-of-life decisions and communication issues. Conflicts negatively impact patient safety, patient/family-centered care, and team welfare and cohesion. They generate staff burnout and increase healthcare costs. Further qualitative studies rooted in social-science theories about workplace conflicts are needed to better understand the typology of ICU conflicts (sources and consequences) and to address complex ICU conflicts that involve systems as opposed to people. Conflict prevention and resolution are complex issues requiring multimodal interventions. Clinical research in this field is insufficiently developed, and no guidelines are available so far. Prevention strategies need to be developed along two axes: improved understanding of family experience, preferences, and values, as well as evidence-based communication may reduce team-family conflicts and organizational measures including restoring leadership, multidisciplinary teamwork, and improved communication within the team may prevent intrateam conflicts in the ICU.
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ABSTRACT: The purpose of this study was to examine the role of physicians on HEC including structural and process features. Four committees were selected from among 12 volunteering to participate with 12 sessions observed. Power analysis (0.8) confirmed an adequate number of communication exchanges, and no statistical significant difference (p < 0.05) among two prior surveys affirmed the sample. Data collection included established questionnaires and communication analyses with a tested method. Results revealed physician presence was robust and similar to prior reports on HEC structure; however, physicians rated their role effectiveness lower than other occupations and lower than overall committee effectiveness. Communication exchanges representing process revealed three positive communication types, and consistent attempts to aid committee functions through consensual processes that also were substantiated by non-physician members. Findings suggested more attention to both structural and process functions of HEC and their members.
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