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

Abstract

Background How should clinical ethics support services such as clinical ethics committees (CECs) be implemented and evaluated? We argue that both the CEC itself and the implementation of the CEC should be considered as ‘complex interventions’. Main text We present a research project involving the implementation of CECs in community care in four Norwegian municipalities. We show that when both the CEC and its implementation are considered as complex interventions, important consequences follow – both for implementation and the study thereof. Emphasizing four such sets of consequences, we argue, first, that the complexity of the intervention necessitates small-scale testing before larger-scale implementation and testing is attempted; second, that it is necessary to theorize the intervention in sufficient depth; third, that the identification of casual connections charted in so-called logic models allows the identification of factors that are vital for the intervention to succeed and which must therefore be studied; fourth, that an important part of a feasibility study must be to identify and chart as many as possible of the causally important contextual factors. Conclusion The conceptualization of the implementation of a CEC as a complex intervention shapes the intervention and the way evaluation research should be performed, in several significant ways. We recommend that researchers consider whether a complex intervention approach is called for when studying CESS implementation and impact.

Establishing Clinical Ethics Committees in Primary Care: A Study from Norwegian Municipal Care

“…The present project involves the implementation of CECs in four Norwegian municipalities. The project has been presented in detail in a separate article (Magelssen et al, 2020a). The municipalities each appointed two "resource persons" who would then assume main responsibility for establishing the CEC and become its leader and secretary.…”

“…CEC work is complex and requires skill, dedication and time (ASBH, 2011;Magelssen et al, 2020a;Schildman et al, 2016). In this light, 2.5 years is not a long time and expectations of what newly established CECs can accomplish in that time should be tempered (Lillemoen et al, 2016).…”

Clinical ethics committees in nursing homes: what good can they do? Analysis of a single case consultation

“…Our group is in the process of conducting such a study, where CECs are established for whole municipalities and not for individual nursing homes. 8 We would welcome further studies from other countries and settings.…”

“…This arguably strengthens our claim made previously that a 'complex intervention' approach to studying CECs is appropriate. 8 Although much academic and professional attention has been on high-profile dilemmas in hospitals, community health and care services (including nursing homes) give rise to a host of moral challenges often of great ethical significance and complexity -probably as much so as in hospitals. 18,19 However, the community setting is marked by less competence and education among staff.…”

“…In our implementation project, the CECs are established at the municipal level in four municipalities, and are intended to serve the entirety of the municipality's health and care services. 8 The four municipalities have populations of approximately 10,000 to > 80,000.…”