Objectives and outcomes of clinical ethics services: a Delphi study

Abstract

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.

Clinical ethics consultations: a scoping review of reported outcomes

“…Previous systematic reviews have highlighted the methodological limitations of studies evaluating CEC effectiveness and the challenges associated with identifying relevant outcomes [ 7 , 36 ]. To address these shortcomings, recent research has attempted to identify relevant outcomes using the Delphi method of consensus [ 95 ]. Although this study represents a strong starting point, it is not comprehensive and did not engage all relevant stakeholders.…”

Towards organisational quality in ethics through patternsandprocess

“…Yet still, ethical climate and moral distress surveys imperfectly encompass all proposed benefits of development of morisprudence , and when expanding the scope from MCD to all CESS, fail to capture patient and family experiences. Further, efforts at standardising and generalising outcomes of CESS continue to demonstrate lack of consensus on quantitative outcomes 7. Notwithstanding these challenges, efforts to better define and assess organisational quality, perhaps via novel application of multiple measures, would be of great benefit in quantifying the value of CESS and other ethics interventions.…”