Summary of findings 2. Request‐based ethics consultation compared to usual care for adult patients.
| Request‐based ethics consultation compared to usual care for adult patients | |||
| Patient or population: adult patients (aged > 18 years) Setting: intensive care units, Taiwan Intervention: request‐based ethics consultationa Comparison: usual care | |||
| Outcomes | Impact | № of participants (studies) | Certainty of the evidence (GRADE) |
| Decisional conflict | The risk (increase in consensus, reduction in decisional conflict) was increased by 80% (RR 0.2, self‐calculated 95% CI 0.09 to 0.46). It was uncertain whether request‐based ethics consultation reduced decisional conflict, because the certainty of the evidence was very low. | 62 (1 RT) | ⊕⊝⊝⊝ Very lowb |
| Moral distress | No studies evaluated the impact of request‐based ethics consultation on moral distress. | — | — |
| Patient involvement in decision‐making | No studies evaluated the impact of request‐based ethics consultation on patient involvement in decision‐making. | — | — |
| Health‐related quality of life | No studies evaluated the impact of request‐based ethics consultation on health‐related quality of life. | — | — |
| Ethical competency | No studies evaluated the impact of request‐based ethics consultation on ethical competency of the healthcare providers participating in ethical case interventions. | — | — |
| Satisfaction with care | No studies evaluated the impact of request‐based ethics consultation on satisfaction with care of healthcare providers, patients and relatives. | — | — |
| *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; RR: risk ratio; 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. | |||
aRequest‐based ethics consultation was performed by an individual ethics consultant. Nurses and physicians could request the ethics consultation. The aim of the intervention was to support patients, families and healthcare providers to address uncertainty or conflict regarding value‐laden issues. bDowngraded three level due to risk of bias, indirectness and imprecision.