Background Evaluating clinical ethics support services (CESS) has been hailed as important research task. At the same time, there is considerable debate about how to evaluate CESS appropriately. The criticism, which has been aired, refers to normative as well as empirical aspects of evaluating CESS. Main body In this paper, we argue that a first necessary step for progress is to better understand the intervention(s) in CESS. Tools of complex intervention research methodology may provide relevant means in this respect. In a first step, we introduce principles of “complex intervention research” and show how CESS fulfil the criteria of “complex interventions”. In a second step, we develop a generic “conceptual framework” for “ethics consultation on request” as standard for many forms of ethics consultation in clinical ethics practice. We apply this conceptual framework to the model of “bioethics mediation” to make explicit the specific structural and procedural elements of this form of ethics consultation on request. In a final step we conduct a comparative analysis of two different types of CESS, which have been subject to evaluation research: “proactive ethics consultation” and “moral case deliberation” and discuss implications for evaluating both types of CESS. Conclusion To make explicit different premises of implemented CESS interventions by means of conceptual frameworks can inform the search for sound empirical evaluation of CESS. In addition, such work provides a starting point for further reflection about what it means to offer “good” CESS.

Trusted evidence. Informed decisions. Better health. Cochrane Database of Systematic Reviews families specifically ask for an ethics consultation to resolve a specific ethical conflict. All studies received public funding and one received additional funding from private sources. Three studies reported on proactive ethics consultation. We found no data on decisional conflict, moral distress, patient involvement in decision-making, quality of life of patients or ethical competency. One study assessed satisfaction with care. It was uncertain whether proactive ethics consultation increased satisfaction with care, because the certainty of the evidence was very low. One study reported on request-based ethics consultation. The study assessed the level of consensus regarding decisions about the care of patients as an indirect criterion for the reduction of decisional conflict. It was uncertain whether request-based ethics consultation increased consensus and, thus, reduced decisional conflict, because the certainty of the evidence was very low. We found no data on moral distress, patient involvement in decision-making, quality of life of patients or ethical competency. How up to date is this review? The review authors searched for studies that were published up to September 2018.