title: Pediatricians' Experience with Clinical Ethics Consultation: A National Survey.
abstract: OBJECTIVE
  To conduct a national survey of pediatricians' access to and experience with clinical ethics consultation.
  
  
  METHODS
  We surveyed a randomly selected sample of 3687 physician members of the American Academy of Pediatrics. We asked about their experiences with ethics consultation, the helpfulness of and barriers to consultation, and ethics education. Using a discrete choice experiment with maximum difference scaling, we evaluated which traits of ethics consultants were most valuable.
  
  
  RESULTS
  Of the total sample of 3687 physicians, 659 (18%) responded to the survey. One-third of the respondents had no experience with clinical ethics consultation, and 16% reported no access to consultation. General pediatricians were less likely to have access. The vast majority (90%) who had experience with consultation had found it helpful. Those with fewer years in practice were more likely to have training in ethics. The most frequently reported issues leading to consultation concerned end-of-life care and conflicts with patients/families or among the team. Intensive care unit physicians were more likely to have requested consultation. Mediation skills and ethics knowledge were the most highly valued consultant characteristics, and representing the official position of the hospital was the least-valued characteristic.
  
  
  CONCLUSIONS
  There is variability in pediatricians' access to ethics consultation. Most respondents reported that consultation had been helpful in the past. Determining ethically appropriate end-of-life care and mediation of disagreements are common reasons that pediatricians request consultation.
authors.affiliation: Pediatric Advanced Care Team, Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Electronic address: morrisonw@email.chop.edu.
authors.forename: Wynne
authors.initials: W
authors.lastname: Morrison
authors.affiliation: Pediatric Advanced Care Team, Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, PA; Temple University School of Medicine, Philadelphia, PA.
authors.forename: James
authors.initials: J
authors.lastname: Womer
authors.affiliation: Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Nathanson
authors.affiliation: Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Kersun
authors.affiliation: Division of Medical Humanities, University of Arkansas for Medical Sciences, Little Rock, AR.
authors.forename: D Micah
authors.initials: DM
authors.lastname: Hester
authors.affiliation: New York University School of Medicine, New York, NY.
authors.forename: Corbett
authors.initials: C
authors.lastname: Walsh
authors.affiliation: Pediatric Advanced Care Team, Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
mesh_terms: D001291:Attitude of Health Personnel; D033061:Ethics Consultation; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D010372:Pediatrics / Q000193:education / Q000941:ethics* / Q000458:organization & administration*; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012955:Societies, Medical; D014481:United States