Objectives and outcomes of clinical ethics services: a Delphi study

Area of Science:

• Medical Ethics
• Healthcare Management
• Clinical Services Evaluation

Background:

• Clinical ethics support services (CESs) play a crucial role in navigating complex ethical dilemmas within healthcare settings.
• Standardized methods for evaluating the effectiveness of CESs are lacking in the USA.
• Understanding appropriate objectives and outcomes is essential for assessing CES performance and impact.

Purpose of the Study:

• To identify and establish consensus on the most appropriate objectives and outcomes for evaluating clinical ethics support services (CESs) in the United States.
• To provide a framework for the development of robust evaluation metrics for CESs.

Main Methods:

• A three-round electronic Delphi (e-Delphi) survey was conducted with medical ethics professionals and experts in the USA.
• Participants reviewed and ranked a list of potential objectives and outcomes for CES evaluation.
• Consensus levels were determined based on participant agreement.

Main Results:

• High agreement was reached on seven key objectives: mediate, educate, develop policy, improve moral quality, counsel, create moral space, and manage moral distress.
• Moderate agreement was found for three additional objectives: empower, awareness of ethics, and preventative ethics.
• Moderate agreement was achieved for five outcomes: ethical justification, institutional transformation, quality of life improvement, principled consensus, and satisfaction with CES expertise.

Conclusions:

• The study successfully identified 10 objectives and 5 outcomes as a starting point for evaluating CESs in the USA.
• The findings highlight the need for continued dialogue to address the diversity of perspectives in the field of clinical ethics support.
• These consensus-based objectives and outcomes can guide the development of standardized evaluation tools for CESs.