Evaluating Clinical Ethics Support: A Participatory Approach

Metselaar, Suzanne; Widdershoven, Guy; Porz, Rouven; Molewijk, Bert

doi:10.1111/bioe.12348

Cited by 26 publications

(27 citation statements)

References 10 publications

(12 reference statements)

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“…Three questionnaires were constructed; to the CEC itself, to clinicians and to patients/next of kin who took part in CEC meetings, respectively. The purpose of the questionnaires was to record experiences with and outcomes from the CEC case consultations, emphasising the outcomes that matter to the stakeholders 12. There were also questions characterising the case itself and the CEC process.…”

Section: Methodsmentioning

confidence: 99%

Importance of systematic deliberation and stakeholder presence: a national study of clinical ethics committees

et al. 2019

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BackgroundCase consultation performed by clinical ethics committees (CECs) is a complex activity which should be evaluated. Several evaluation studies have reported stakeholder satisfaction in single institutions. The present study was conducted nationwide and compares clinicians’ evaluations on a range of aspects with the CEC’s own evaluation.MethodsProspective questionnaire study involving case consultations at 19 Norwegian CECs for 1 year, where consultations were evaluated by CECs and clinicians who had participated.ResultsEvaluations of 64 case consultations were received. Cases were complex with multiple ethical problems intertwined. Clinicians rated the average CEC consult highly, being both satisfied with the process and perceiving it to be useful across a number of aspects. CEC evaluations corresponded well with those of clinicians in a large majority of cases. Having next of kin/patients present was experienced as predominantly positive, though practised by only half of the CECs. The educational function of the consult was evaluated more positively when the CEC used a systematic deliberation method.ConclusionsCEC case consultation was found to be a useful service. The study is also a favourable evaluation of the Norwegian CEC system, implying that it is feasible to implement well-functioning CECs on a large scale. There are good reasons to involve the stakeholders in the consultations as a main rule.

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Section: Methodsmentioning

confidence: 99%

Importance of systematic deliberation and stakeholder presence: a national study of clinical ethics committees

et al. 2019

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“…In the studies of Weidema, Molewijk, Widdershoven, and Abma (), Weidema et al () and in other Dutch MCD studies (Metselaar, Widdershoven, Porz, & Molewijk, ; Molewijk, Zadelhoff, Lendemeijer, & Widdershoven, ), responsive evaluation was used, meaning that stakeholders contributed with their knowledge and insider perspective in the process. In the present study, which is part of the larger Euro‐MCD project (, observational design is applied.…”

Section: Literature Reviewmentioning

confidence: 99%

Impact of clinical ethics support on daily practice—First‐line managers’ experiences in the Euro‐MCD project

Silén

Svantesson

2019

J Nurs Manag

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Aim To explore first‐line managers’ experiences of what Moral Case Deliberation has meant for daily practice, to describe perceptions of context influence and responsibility to manage ethically difficult situations. Background In order to find measures to evaluate Moral Case Deliberation, the European Moral Case Deliberation Outcome instrument was developed and is now in the stage of revision. For this, there is a need of several perspectives, one of them being the managerial bird‐eye perspective. Method Eleven first‐line managers at workplaces, participating in the European Moral Case Deliberation Outcome instrument project, were interviewed and thematic analysis was applied. Results Managers’ experiences were interpreted as enhanced ethical climate: a closer‐knit and more emotionally mature team, morally strengthened individuals, as well as ethics leaving its marks on everyday work and morally grounded actions. Despite organizational barriers, they felt inspired to continue ethics work. Conclusion and Implications This study confirmed, but also added ethical climate aspects, such as morally grounded actions. Furthermore, adding ethical climate as a construct in the European Moral Case Deliberation Outcome instrument should be considered. First‐line managers need clear directives from their managers that ethics work needs to be prioritized for the good of both the staff and the patients.

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“…The maturation of clinical ethics outside the USA has a different shape to it. For instance, in Europe, the target construct is not consultation, but a broader interest in CESs, which includes consultation as well as clinical ethics committees and moral case deliberation (MCD) 13–16. Additionally, the European Clinical Ethics Network (ECEN) has been proactive in their discussion of outcome measures for these services, convening a working group on evaluation, and explicitly recognising the normativity inherent in choosing outcome measures.…”

Section: Introductionmentioning

confidence: 99%

Objectives and outcomes of clinical ethics services: a Delphi study

2019

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ObjectivesTo explore the objectives and outcomes most appropriate for evaluating clinical ethics support services (CESs) in the USA.MethodsA three-round e-Delphi was sent to two professional medical ethics listservs (Medical College of Wisconsin-Bioethics and American Society for Bioethics and Humanities) as well as 19 individual experts. The survey originally contained 15 objectives and 9 outcomes. In round 1, participants were asked to validate the content of these lists. In round 2, we had 17 objectives and 10 outcomes, and participants were asked to rank them for appropriateness in a top 10 list of objectives and a top 5 list of outcomes.ResultsParticipants came to a high(at least 70%) level of agreement on seven objectives: mediate, educate, develop policy, improve the moral quality of a decision or action, counsel, create a moral space and manage moral distress. Participants came to a moderate (at least 51%) level of agreement on three objectives: empower, awareness of ethics and preventative ethics. Participants also came to a moderate (at least 51%) level of agreement on five outcomes: ethical justification, transformation of institution, improvement of quality of life, principled consensus and satisfaction with the expertise of a CES.ConclusionThis e-Delphi identified 10 objectives and 5 outcomes that are a good starting point for developing outcome measures to evaluate CESs in the USA, while reminding us of the diversity of perspectives still evident in the field.

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Evaluating Clinical Ethics Support: A Participatory Approach

Cited by 26 publications

References 10 publications

Importance of systematic deliberation and stakeholder presence: a national study of clinical ethics committees

Importance of systematic deliberation and stakeholder presence: a national study of clinical ethics committees

Impact of clinical ethics support on daily practice—First‐line managers’ experiences in the Euro‐MCD project

Objectives and outcomes of clinical ethics services: a Delphi study

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