P. N. Chotai1, M. B. Patel1, B. M. Dennis1, O. D. Guillamondegui1, K. G. Meador2, K. A. Wallston3, A. B. Peetz1 1Vanderbilt University Medical Center,Division Of Trauma And Acute Care Surgery, Department Of General Surgery,Nashville, TN, USA 2Vanderbilt University Medical Center,Center For Biomedical Ethics And Society At Vanderbilt,Nashville, TN, USA 3Vanderbilt University Medical Center,Institute Of Medicine And Public Health,Nashville, TN, USA
Introduction:
Trauma surgeons may often encounter complex patient situations that can be considered ethical challenges. These may require unique decision-making skills. Current literature is scarce in describing and characterizing ethical issues encountered by practicing trauma surgeons. We hypothesize variable incidence and estimates of self-efficacy of trauma surgeons’ ability to manage ethical problems in clinical practice.
Methods:
We surveyed members of the Eastern Association for the Surgery of Trauma (EAST) from January 5 to February 7, 2018 to ascertain their opinions and readiness on handling ethically challenging scenarios in their clinical trauma practice using a web-accessible survey via e-mail. The survey instrument was developed using published ethics literature and informal cognitive interviews of small focus groups that included trauma surgeons, physicians, ethicists, and other practitioners. Domains covered included perceived frequency and ability to manage ethical situations that present problems in trauma surgery practice. Common situations were defined as those situations that respondents encountered monthly or weekly. The ethical problems were categorized within seven larger categories: General ethics, Autonomy, Communication, Justice, End of Life, Conflict, and Other. Quantitative and qualitative analyses of the data were performed.
Results:
The response rate for the survey was 30.6% (548 respondents from 1794 invites); 28% of the respondents were female. Most respondents were white (74.6%) and under 55 years old (72.6%). A majority (85.4%) of respondents had completed fellowship training in either surgical critical care or trauma/acute care surgery. Most respondents (86.6%) reported clinical practice in an American College of Surgeons (ACS) verified level I or II trauma center. The most commonly encountered ethical categories were Generic Ethical and Communication (79% of respondents reported that these were common issues in their clinical practice). Issues involving Conflict were least frequent (only 21% of respondents encountered these conflict issues on a monthly or weekly basis). Respondents’ ability to handle ethical situations did not differ among race or gender groups, size or geographic location of city of practice, completion of a fellowship training in trauma surgery, or trauma center verification level. Surgeons who reported high ability to handle ethical situations were more likely to be older (p=0.003), had been in practice 15 years or longer (linear relationship, rho = 0.21, p<0.001), had previously served on an ethics committee (p=0.038), and more frequently experienced ethically challenging situations in their clinical practice (p<0.05). Table 1 summarizes commonly encountered ethical situations in trauma surgery practice.
Conclusion:
An overwhelming majority of trauma surgeons encounter a range of ethical challenges on a regular basis in their clinical practice. Compared to younger and early career trauma surgeons, older and advanced career trauma surgeons reported higher ability and self-efficacy to manage ethical issues in clinical practice. To our knowledge, this is the first study to describe some of the unique ethical challenges that trauma surgeons face. We also identify a gap in knowledge regarding how trauma surgeons develop in addressing these problems effectively.
