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Perceptions of Clinical Ethics Practices: IntegratedEthicsTM Staff Survey Data from the VA Health Care System

机译：对临床道德规范的看法：来自VA卫生保健系统的IntegratedEthicsTM员工调查数据

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Background: Clinical ethics is fundamental to the quality of health care and is a concern facing all health care systems. This study examined clinicians' perceptions of ethical practices in shared decision making with patients, end-of-life care, professionalism in patient care, and patient privacy and confidentiality in order to identify strengths in ethical practices and opportunities for improvement. Methods:We analyzed data from the 48,857 clinician respondents to the 2010 IntegratedEthics~(TM) Staff Survey (IESS). The IESS was developed to provide a broad snapshot of a health care organization's ethical practices for quality improvement purposes. We used descriptive statistics to evaluate clinicians' perceptions of clinical ethics practices and multivariate logistic regression analyses to evaluate associations between clinicianand organization-level characteristics and positive ethical practices. Results: Survey results suggest opportunities for improvement in ethical practices, including giving patients sufficient time to discuss treatment recommendations, giving better guidance to clinicians on how tomaintain professional boundaries, disclosing medical errors to patients and surrogates, and providing clinicians with better education about ethical issues in end-of-life care. The majority of respondents were familiar with the ethics consultation service (ECS). Familiarity with the ECS was significantly associated with length of time working at VA, physician status, and manager/supervisory level of responsibility. If confronted with an ethical concern, approximately three-quarters of respondents reported that they would be very or moderately likely to use the ECS. Conclusions: The results from this study support quality improvement activities by allowing health care organizations to compare clinical ethics practices across staff groups, settings, and time. After a facility obtains its results, the next steps should include seeking greater understanding through qualitative interviews, and then selecting topics for quality improvement initiatives. These activities will reinforce the importance of ethics as a component of health care quality and promote a positive ethics environment.
机译：背景：临床伦理是卫生保健质量的基础，也是所有卫生保健系统都面临的问题。这项研究检查了临床医生在与患者共享决策，临终关怀，患者护理专业性以及患者隐私和机密性方面对道德规范的看法，以便确定道德规范的优势和改进机会。方法：我们分析了来自2010年IntegratedEthics〜（TM）人员调查（IESS）的48857名临床医生的数据。 IESS的开发旨在为质量改进目的提供卫生保健组织道德实践的广泛概况。我们使用描述性统计数据来评估临床医生对临床伦理实践的看法，并使用多元逻辑回归分析来评估临床医生与组织级特征与积极的伦理实践之间的关联。结果：调查结果显示了改善道德规范的机会，包括给予患者足够的时间来讨论治疗建议，为临床医生提供更好的指导以保持专业界限，向患者和代理人披露医疗错误以及为临床医生提供有关道德问题的更好的教育在临终关怀中。大多数受访者熟悉道德咨询服务（ECS）。熟悉ECS与在VA上工作的时间长短，医师身份以及经理/主管的职责水平显着相关。如果遇到道德问题，大约四分之三的受访者表示，他们将非常或中等地使用ECS。结论：这项研究的结果通过允许医疗保健组织比较员工组，环境和时间的临床道德规范来支持质量改进活动。工厂获得结果后，下一步应包括通过定性访谈寻求更多了解，然后选择质量改进计划的主题。这些活动将加强道德操守作为医疗保健质量组成部分的重要性，并促进积极的道德操守环境。

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