Ethical climate and intention to leave among critical care clinicians: an observational
study in 68 intensive care units across Europe and the United States
Van den Bulcke, Bo ✉; Metaxa, Victoria; Reyners, Anna K.; Rusinova, Katerina; Jensen, Hanne I.; Malmgren, J.; Darmon, Michael; Talmor, Daniel; Meert, Anne-Pascale; Cancelliere, Laura; Zubek, Laszlo [Zubek, László (Aneszteziológia), szerző] Aneszteziológiai és Intenzív
Terápiás Klinika (SE / AOK / K); Maia, Paulo; Michalsen, Andrej; Kompanje, Erwin J. O.; Vlerick, Peter; Roels, Jolien; Vansteelandt, Stijn; Decruyenaere, Johan; Azoulay, Elie; Vanheule, Stijn; Piers, Ruth; Benoit, Dominique; DISPROPRICUS study group of the Ethics Section of the ESICM [Kollaborációs szervezet]
Angol nyelvű Sokszerzős vagy csoportos szerzőségű szakcikk (Folyóiratcikk) Tudományos
PurposeApart from organizational issues, quality of inter-professional collaboration
during ethical decision-making may affect the intention to leave one's job. To determine
whether ethical climate is associated with the intention to leave after adjustment
for country, ICU and clinicians characteristics.MethodsPerceptions of the ethical
climate among clinicians working in 68 adult ICUs in 12 European countries and the
US were measured using a self-assessment questionnaire, together with job characteristics
and intent to leave as a sub-analysis of the Dispropricus study. The validated ethical
decision-making climate questionnaire included seven factors: not avoiding decision-making
at end-of-life (EOL), mutual respect within the interdisciplinary team, open interdisciplinary
reflection, ethical awareness, self-reflective physician leadership, active decision-making
at end-of-life by physicians, and involvement of nurses in EOL. Hierarchical mixed
effect models were used to assess associations between these factors, and the intent
to leave in clinicians within ICUs, within the different countries.ResultsOf 3610
nurses and 1137 physicians providing ICU bedside care, 63.1% and 62.9% participated,
respectively. Of 2992 participating clinicians, 782 (26.1%) had intent to leave, of
which 27% nurses, 24% junior and 22.7% senior physicians. After adjustment for country,
ICU and clinicians characteristics, mutual respect OR 0.77 (95% CI 0.66- 0.90), open
interdisciplinary reflection (OR 0.73 [95% CI 0.62-0.86]) and not avoiding EOL decisions
(OR 0.87 [95% CI 0.77-0.98]) were all associated with a lower intent to leave.ConclusionThis
is the first large multicenter study showing an independent association between clinicians'
intent to leave and the quality of the ethical climate in the ICU. Interventions to
reduce intent to leave may be most effective when they focus on improving mutual respect,
interdisciplinary reflection and active decision-making at EOL.
