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Lawrence J Schneiderman

Publications and source records attributed to Lawrence J Schneiderman.

At least 19 recordsLinked to original sources
PubMed2006

Effect of ethics consultations in the intensive care unit.

Although evidence-based research is limited, results suggest that ethics consultations are associated with reductions in hospital days and intensive care unit days and in life-sustaining treatments in those patients who ultimately will not survive to discharge. Furthermore, the majority of healthcare providers and patients/surrogates agreed that ethics consultations in the intensive care unit were helpful in addressing treatment conflicts. Ethics consultations also reduce hospital costs without diminishing the quality of care. Hence, ethics consultations seem to be useful in resolving conflicts that may be inappropriately prolonging nonbeneficial or unwanted treatments at the end of life. Further research on whether ethics consultations are beneficial in other settings is needed to establish the optimal scope of this intervention. Also, the benefits described above were achieved by highly skilled and experienced consultants. It is not certain, therefore, how successful other hospitals will be when adopting this intervention.

Communication↗
PubMed2006

Proposed quality measures for palliative care in the critically ill: a consensus from the Robert Wood Johnson Foundation Critical Care Workgroup.

For critically ill patients and their loved ones, high-quality health care includes the provision of excellent palliative care. To achieve this goal, the healthcare system needs to identify, measure, and report specific targets for quality palliative care for critically ill or injured patients. Our objective was to use a consensus process to develop a preliminary set of quality measures to assess palliative care in the critically ill. We built on earlier and ongoing efforts of the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup to propose specific measures of the structure and process of palliative care. We used an informal iterative consensus process to identify and refine a set of candidate quality measures. These candidate measures were developed by reviewing previous literature reviews, supplementing the evidence base with recently published systematic reviews and consensus statements, identifying existing indicators and measures, and adapting indicators from related fields for our objective. Among our primary sources, we identified existing measures from the Voluntary Hospital Association's Transformation of the ICU program and a government-sponsored systematic review performed by RAND Health to identify palliative care quality measures for cancer care. Our consensus group proposes 18 quality measures to assess the quality of palliative care for the critically ill and injured. A total of 14 of the proposed measures assess processes of care at the patient level, and four measures explore structural aspects of critical care delivery. Future research is needed to assess the relationship of these measures to desired health outcomes. Subsequent measure sets should also attempt to include outcome measures, such as patient or surrogate satisfaction, as the field develops the means to rigorously measure such outcomes. The proposed measures are intended to stimulate further discussion, testing, and refinement for quality of care measurement and enhancement.

Continuity of Patient Care↗
PubMed2005

The perils of hope.

Explore the source record for details and available documents.

Adaptation, Psychological↗
PubMed2005

Ethics consultation in the intensive care unit.

PURPOSE OF REVIEW: To review the medical literature for recent reports of the role of ethics consultations in the intensive care setting. RECENT FINDINGS: Ethical principles can provide important guidelines for dealing with value conflicts in medical treatment decisions, particularly treatment decisions to limit life-sustaining treatment in the intensive care unit. Until recently, advocates of ethics consultations have had to rely on inconclusive supporting data. In the past few years, however, a single-site and multi-site prospective randomized controlled trial of the ethics consultations offered in response to treatment conflicts in the intensive care unit demonstrated significant reductions in hospital days, hospital costs, and ventilator days in patients who did not survive to hospital discharge. The consultations were very well received by all the parties. SUMMARY: Ethics consultations seem to be useful in resolving conflicts that may be inappropriately prolonging nonbeneficial or unwanted treatments at the end of life. Further research on whether ethics consultations are beneficial in other settings is needed to establish the optimal scope of this intervention. Also, because these benefits were achieved by highly skilled and experienced consultants, it is not certain how successful other hospitals will be when adopting this intervention.

Ethics Consultation↗
PubMed2003

Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial.

CONTEXT: Ethics consultations increasingly are being used to resolve conflicts about life-sustaining interventions, but few studies have reported their outcomes. OBJECTIVE: To investigate whether ethics consultations in the intensive care setting reduce the use of life-sustaining treatments delivered to patients who ultimately did not survive to hospital discharge, as well as the reactions to the consultations of physicians, nurses, and patients/surrogates. DESIGN: Prospective, multicenter, randomized controlled trial from November 2000 to December 2002. SETTING: Adult intensive care units (ICUs) of 7 US hospitals representing a spectrum of institutional characteristics. PATIENTS: Five hundred fifty-one patients in whom value-related treatment conflicts arose during the course of treatment. INTERVENTIONS: Patients were randomly assigned either to an intervention (ethics consultation offered) (n = 278) or to usual care (n = 273). MAIN OUTCOME MEASURES: The primary outcomes were ICU days and life-sustaining treatments in those patients who did not survive to hospital discharge. We examined the same measures in those who did survive to discharge and also compared the overall mortality rates of the intervention and usual care groups. We also interviewed physicians and nurses and patients/surrogates about their views of the ethics consultation. RESULTS: The intervention and usual-care groups showed no difference in mortality. However, ethics consultations were associated with reductions in hospital (-2.95 days, P =.01) and ICU (-1.44 days, P =.03) days and life-sustaining treatments (-1.7 days with ventilation, P =.03) in those patients who ultimately did not survive to discharge. The majority (87%) of physicians, nurses, and patients/surrogates agreed that ethics consultations in the ICU were helpful in addressing treatment conflicts. CONCLUSION: Ethics consultations were useful in resolving conflicts that may have inappropriately prolonged nonbeneficial or unwanted treatments in the ICU.

Adult↗
PubMed2002

Economic and health consequences of selling a kidney in India.

CONTEXT: Many countries have a shortage of kidneys available for transplantation. Paying people to donate kidneys is often proposed or justified as a way to benefit recipients by increasing the supply of organs and to benefit donors by improving their economic status. However, whether individuals who sell their kidneys actually benefit from the sale is controversial. OBJECTIVE: To determine the economic and health effects of selling a kidney. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional survey conducted in February 2001 among 305 individuals who had sold a kidney in Chennai, India, an average of 6 years before the survey. MAIN OUTCOME MEASURES: Reasons for selling kidney, amount received from sale, how money was spent, change in economic status, change in health status, advice for others contemplating selling a kidney. RESULTS: Ninety-six percent of participants sold their kidneys to pay off debts. The average amount received was 1070 US dollars. Most of the money received was spent on debts, food, and clothing. Average family income declined by one third after nephrectomy (P<.001), and the number of participants living below the poverty line increased. Three fourths of participants were still in debt at the time of the survey. About 86% of participants reported a deterioration in their health status after nephrectomy. Seventy-nine percent would not recommend that others sell a kidney. CONCLUSIONS: Among paid donors in India, selling a kidney does not lead to a long-term economic benefit and may be associated with a decline in health. Physicians and policy makers should reexamine the value of using financial incentives to increase the supply of organs for transplantation.

Cross-Sectional Studies↗
PubMed1991

Is it morally justifiable not to sedate this patient before ventilator withdrawal?

In their case description and analysis, Barbara Springer Edwards and Winston M. Ueno provide a nice opportunity to examine the intersection of theory and practice in medical ethics, as well as to discuss the fine tuning of treatment decisions in the clinical setting. They raise the question: Is it morally justifiable to sedate an alert patient before his life-supporting ventilator is disconnected? Clearly they have a thorough understanding of their patient's legal and ethical entitlement to have his request for discontinuation of life-supporting treatment honored. They also recognize the principle of double effect in allowing large doses of medication to control pain even at the risk of accelerating death. My doubts lie in their specific application of the notion of beneficence, a principle that involves mainly two objectives: preservation of life and alleviation of suffering....

Altruism↗
PubMedDate not supplied

The costs of nonbeneficial treatment in the intensive care setting.

Ethics consultations have been shown to reduce the use of "nonbeneficial treatments," defined as life-sustaining treatments delivered to patients who ultimately did not survive to hospital discharge, when treatment conflicts occurred in the adult intensive care unit (ICU). In this paper we estimated the costs of nonbeneficial treatment using the results from a randomized trial of ethics consultations. We found that ethics consultations were associated with reductions in hospital days and treatment costs among patients who did not survive to hospital discharge. We conclude that consultations resolved conflicts that would have inappropriately prolonged nonbeneficial or unwanted treatments in the ICU instead of focusing on more appropriate comfort care.

Adult↗