Evidence map›Paper›PMID 29475979›Full record

ArticleBMJ quality & safety2018

Ethical decision-making climate in the ICU: theoretical framework and validation of a self-assessment tool.

Bo Van den Bulcke, Ruth Piers, Hanne Irene Jensen, Johan Malmgren, Victoria Metaxa, Anna K Reyners, Michael Darmon, Katerina Rusinova, Daniel Talmor, Anne-Pascale Meert and 13 more

Registry-linked trialAbstract readValidation Study
PubMed Publisher
In one paragraph

Article in BMJ quality & safety, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05167019 (Coaching Doctors to Improve Ethical Decision-making in Adult Hospitalized Patients Potentially Receiving Excessive Treatment), which is not on this map. Cited by 38 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
38citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05167019 nacompletednot on this mapstarted 2022, after this paper: background citation

Coaching Doctors to Improve Ethical Decision-making in Adult Hospitalized Patients Potentially Receiving Excessive Treatment: a Step Wedge Cluster Randomized Trial in 10 Departments of the Ghent University Hospital (CODE)

TypeinterventionalSponsorUniversity Hospital, GhentRan2022 to 2024Enrolled125ConditionsEnd of Life, Interdisciplinary Communication, LeadershipArmsCODE intervention, Usual care
3 · Its place in the literature

Who cites it

38 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

23 authors.

Bo Van den BulckeDepartment of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.ORCID 0000-0001-5379-8886
Ruth PiersGeriatrics, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.
Hanne Irene JensenDepartment of Anaesthesiology and Intensive Care, Sygehus Lillebælt Vejle Sygehus, Vejle, Denmark.
Johan MalmgrenDepartment of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
Victoria MetaxaKing's College Hospital, London, UK.
Anna K ReynersDepartment of Medical Oncology, University of Groningen, Groningen, Netherlands.
Michael DarmonMedical-Surgical Intensive Care Unit, Hopital NordSaint-Etienne University Hospital, Saint-Etienne, France.
Katerina RusinovaDepartment of Anaesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Daniel TalmorDepartment of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
Anne-Pascale MeertService des Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, ULB, Bruxelles, Belgium.
Laura CancelliereSCDU Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria, 'Maggiore della Carità', Novara, Italy.
Làszló ZubekDepartment of Anesthesiology and Intensive Therapy, Semmelweis University Budapest, Budapest, Hungary.
Paolo MaiaDepartment of Intensive Care, Hospital de Santo António, Porto, Portugal.
Andrej MichalsenDepartment of Anaesthesiology and Critical Care Medicine, Tettnang Hospital, Tettnang, Germany.
Johan DecruyenaereDepartment of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
Erwin J O KompanjeDepartment of Intensive Care, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Elie AzoulayMedical Intensive Care Unit, Hôpital Saint-Louis and University Paris-7, Paris, France.
Reitske MeganckDepartment of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium.
Ariëlla Van de SompelDepartment of Applied Mathematics, Computer Sciences and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium.
Stijn VansteelandtDepartment of Applied Mathematics, Computer Sciences and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium.
Peter VlerickDepartment of Personnel Management, Work and Organizational Psychology, Ghent University, Ghent, Belgium.
Stijn VanheuleDepartment of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.
Dominique D BenoitDepartment of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLiterature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU).

objectivesTo better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates.

methodsUsing a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment. This instrument was subsequently validated among clinicians working in 68 adult ICUs in 13 European countries and the USA. Exploratory and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians. Measurement invariance was tested to make sure that variables used in the analysis were comparable constructs across different groups.

resultsOf 3610 nurses and 1137 physicians providing ICU bedside care, 2275 (63.1%) and 717 (62.9%) participated respectively. Statistical analyses revealed that a shortened 32-item version of the EDMCQ scale provides a factorial valid measurement of seven facets of the extent to which clinicians perceive an EDM climate: self-reflective and empowering leadership by physicians; practice and culture of open interdisciplinary reflection; culture of not avoiding end-of-life decisions; culture of mutual respect within the interdisciplinary team; active involvement of nurses in end-of-life care and decision-making; active decision-making by physicians; and practice and culture of ethical awareness. Measurement invariance of the EDMCQ across occupational groups was shown, reflecting that nurses and physicians interpret the EDMCQ items in a similar manner.

conclusionsThe 32-item version of the EDMCQ might enrich the EDM climate measurement, clinicians' behaviour and the performance of healthcare organisations. This instrument offers opportunities to develop tailored ICU team interventions.

Indexed as

Intensive Care UnitsOrganizational CultureSelf-AssessmentDecision MakingHumansMedical Staff, HospitalModels, Theoreticalcommunicationcritical caredecision-makingteamwork

Identifiers

PMID29475979

What OpenQuestion holds

Textmetadata
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.