How Do I get an Ethics Consultation? Comparing Barriers to Ethics Consultation in Pediatric Inpatient and Outpatient Settings

Objective: Ethics consults are important avenues for discussion of complex decision making in the clinical setting. Few studies have looked at barriers to ethics consults in the pediatric setting, especially in the outpatient setting. This study aimed to characterize ethics consult utilization at a pediatric non-profit healthcare system, with a particular focus on how medical provider perceptions inform ethics consultation requests in both inpatient and outpatient settings. Methods: We surveyed healthcare providers and asked about previous experiences with the ethics consult service, potential barriers to obtaining consults, and factors that would make them more likely to obtain a consult in the future. The survey was distributed electronically via email. Results: Of 598 total providers, 139 completed the survey (23% response rate). Respondents were mostly physicians and nurse practitioners from critical care, hematology/oncology or outpatient general pediatrics. In the inpatient setting, identified barriers to ethics consultations included: not wanting to upset the patient or family, not wanting to upset colleagues, and not knowing if they were dealing with an ethical issue. In the outpatient setting, respondents reported not knowing how to place a consult or if they were allowed to do so as outpatient providers. Conclusions: Providers identified several barriers to ethics consults, and barriers differed according to clinical setting. These findings highlight the need to address general barriers to pediatric ethics consultation, including education on the logistics of an ethics consult and how to mitigate unease about initiating a consult, but also practice-specific barriers as experienced by inpatient and outpatient providers.