Summary of findings for the main comparison. Proactive ethics consultation compared to usual care for adult patients.
| Proactive ethics consultation intervention compared to usual care for adult patients | |||
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Patient or population: adult patients (aged > 18 years)
Setting: intensive care units in USA Intervention: proactive ethics consultationa Comparison: usual care | |||
| Outcomes | Impact | № of participants (studies) | Certainty of the evidence (GRADE) |
| Decisional conflict | No studies evaluated the impact of proactive ethics consultation on decisional conflict. | — | — |
| Moral distress | No studies evaluated the impact of proactive ethics consultation on moral distress. | — | — |
| Patient involvement in decision‐making | No studies evaluated the impact of proactive ethics consultation on patient involvement in decision‐making. | — | — |
| Health‐related quality of life | No studies evaluated the impact of proactive ethics consultation on health‐related quality of life. | — | — |
| Ethical competency | No studies evaluated the impact of proactive ethics consultation on ethical competency of the healthcare providers participating in ethical case interventions. | — | — |
| Satisfaction with care | It was uncertain whether proactive ethics consultation increased satisfaction with care of the healthcare providers (86.1% rated this as positive; P = 0.05) or relatives (74.8% rated this as positive; P > 0.05), because the certainty of the evidence was very low. | 478 (1 RT) | ⊕⊝⊝⊝ Very lowb |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RT: randomised trial. | |||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | |||
aProactive ethical conflict was performed by an individual ethicist who acted in case of a length of stay in the ICU of five or more days. The aim of this intervention was to gather ethically important information and if necessary to intervene before the emergence of an ethics conflict. bDowngraded two levels due to risk of bias and imprecision.