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

Abstract

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.

Evaluating assessment tools of the quality of clinical ethics consultations: a systematic scoping review from 1992 to 2019

“…Feedback from patients and family members [14,69,74,91,92,114,130,131] iv. Input from healthcare professionals [5,14,15,33,72,74,80,85,87,90,91,98,103,111,112,114,118,119,127,130] v. Evaluations by senior clinicians [82,84,93,102,104,127] vi. Evaluations by administrators or organizational representatives [77] Assessments methods also include:…”

“…It is hoped that mapping prevailing methods of assessing CECons will guide the design of a robust CECons assessment tool. This need to address this lack of an assessment tool to evaluate the approach, quality and content of CECcons [32], assess its long-term effects on patient care and safety [6,33] and standardise and benchmark practice [34] is further underlined by evidence of variations in CEC practice and CECcons methods that will ultimately undermine the efficacy and standing of CECs as a whole. Better understanding of how CECs meet this key role will also improve oversight and improvements to quality standards and guidelines of CECs [35,36].…”

“…An effective CEC consultant also showed interest in organizational ethics [7], educating and guiding others on ethical issues [80,91,92] and aligning expectations and practice with institutional and CEC standards [82,86]. Some studies evaluated all members of the CECons as a whole [22,33,97] and their ability to provide a broad review of ethico-legal and moral considerations [73,98].…”

Implementing clinical ethics committees as a complex intervention: presentation of a feasibility study in community care

“…In sum, a complex intervention framework involves awareness that implementation takes place in a specific context and interacts with its surroundings in a myriad of ways, not all of which can be predicted. In contrast, more traditional evaluation research on CECs has typically been more narrow, studying outcomes such as stakeholder views and appreciation [4]. In doing so these studies are likely to have missed knowledge which would be helpful for the implementation of new CECs.…”

“…Ethics deliberation in the CEC is an opportunity for stakeholders to present their viewpoints, contributing to a fuller picture of the ethical challenge at hand. Norwegian CECs attempt to include stakeholders in cases where they are involved, and the strengthening of patient autonomy and shared decision-making in the services is an underlying ethical commitment for the CEC [4]. Stakeholder perspectives and feedback must be used constructively by the CECs and by the project for quality improvement including refinement of routines in connection with case deliberations.…”