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

Nicholas Yue Shuen Yoon,Clarissa Wei Shuen Cheong,Yun Ting Ong,Ying Pin Toh,Elijah Gin Lim,Lalit Kumar Radha Krishna,Stephen Mason,Hong Wei Yap,Kuang Teck Tay,Min Chiam,Wei Qiang Lim,Annelissa Mien Chew Chin

doi:10.1186/s12910-020-00492-4

Abstract

BackgroundAmidst expanding roles in education and policy making, questions have been raised about the ability of Clinical Ethics Committees (CEC) s to carry out effective ethics consultations (CECons). However recent reviews of CECs suggest that there is no uniformity to CECons and no effective means of assessing the quality of CECons. To address this gap a systematic scoping review of prevailing tools used to assess CECons was performed to foreground and guide the design of a tool to evaluate the quality of CECons.MethodsGuided by Levac et al’s (2010) methodological framework for conducting scoping reviews, the research team performed independent literature reviews of accounts of assessments of CECons published in six databases. The included articles were independently analyzed using content and thematic analysis to enhance the validity of the findings.ResultsNine thousand sixty-six abstracts were identified, 617 full-text articles were reviewed, 104 articles were analyzed and four themes were identified – the purpose of the CECons evaluation, the various domains assessed, the methods of assessment used and the long-term impact of these evaluations.ConclusionThis review found prevailing assessments of CECons to be piecemeal due to variable goals, contextual factors and practical limitations. The diversity in domains assessed and tools used foregrounds the lack of minimum standards upheld to ensure baseline efficacy.To advance a contextually appropriate, culturally sensitive, program specific assessment tool to assess CECons, clear structural and competency guidelines must be established in the curation of CECons programs, to evaluate their true efficacy and maintain clinical, legal and ethical standards.

Highlights

Facing shifts in sociocultural paradigms, resource pressures and increasing complexities of medical care [1], the role of Clinical Ethics Committees (CEC)s has evolved
The four themes/categories elucidated were the purpose of the carry out effective ethics consultations (CECons) evaluation, the various domains assessed, the methods of assessment used and the long-term impact of these evaluations
CECons were assessed to determine their impact on patient care [18, 71,72,73,74,75] and benchmark their programs against prevailing standards [17, 76, 77]

Summary

Introduction

Facing shifts in sociocultural paradigms, resource pressures and increasing complexities of medical care [1], the role of Clinical Ethics Committees (CEC)s has evolved. Whilst retaining its original role in facilitating “the process and outcomes of patient care by helping to identity, analyze, and resolve” ethical, moral and legal issues in clinical care [2] CECs have come to adopt active roles in education and policy making. To meet these goals, the CEC which is understood to be “[a team of] physicians, social workers, attorneys, and theologians...which serves to review the individual circumstances of ethical dilemma and which has [previously shown to provide] much in the way of assistance and safeguards for patients and their medical caretakers” [3] educate patients, their families, clinicians, and the host organization as it guides them through the conflicts and uncertainties impacting their specific healthcare situation [4, 5].

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Conclusion