Group-model ethics consultations as an adjunct to Advanced Care Planning
Friday, October 13, 2023
5:00 PM – 6:15 PM ET
Location: Essex AB (Fourth Floor)
Advanced Care Planning (ACP) has been widely utilized over the last 30 years as a method to ensure the delivery of goal concordant care near the end of life. However, recent large-scale reviews of ACP efficacy suggest the standalone strategy, focused principally on the establishment of advance directives and the designation of future substitute decision makers, is insufficient to reliably achieve this objective. We sought to explore the additive role of ethics consultation in guiding end-of-life decisions in the absence or presence of ACP. Our retrospective quality improvement project analyzed over 160 group-model ethics consultations conducted at a major academic medical center in New York City over three years. We found that 84% of patients lacked an advance directive, while 79% percent also lacked an established health care proxy. Despite the low prevalence of ACP in our sample, 24% of consultations resulted in a change to a patient’s code status. This finding suggests that patients and their loved ones, as well as clinicians, could benefit from our model of decision-making and ethical analysis to guide end of life decisions. Moreover, ethics consultations may serve both an adjunctive role in clarifying patients’ existing ACP, as well as a primary function to help interpret patient values and goals of care. In this way, we aim to explore how clinical ethics may be beneficial in addressing the real-time complexities and emotionally laden dynamics of a patient’s end of life course compared to ACP alone.
Julia Kolak – Bioethics Program in Medical Education – Mount Sinai Hospital; Krishna Chokshi – Internal Medicine – Mount Sinai Hospital; Isabelle Band – School of Medicine – Icahn School of Medicine at Mount Sinai; Cecilia Katzenstein – School of Medicine – Icahn School of Medicine at Mount Sinai; Regina Longley – School of Medicine – Icahn School of Medicine at Mount Sinai