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Clinical ethics support services in paediatric practice: protocol for a mixed studies systematic review on
Mariana Dittborn1,2, Bernardita Portales2, Joe Brierley3
1Paediatric Bioethics Centre, Great Ormond Street Hospital for Children, London, UK mariana.dittborn@gmail.com.
Insights
This systematic review synthesizes evidence on pediatric clinical ethics support services (p-CESS), evaluating their structures, processes, and outcomes. Findings will inform quality standards and future research for these vital services.
Area of Science:
- Medical Ethics
- Pediatric Healthcare Quality
- Systematic Review Methodology
Background:
- Clinical ethics support services (CESS) are increasingly recognized globally.
- Paediatric-specific CESS (p-CESS) have received limited research attention.
- Existing adult CESS evidence may not be generalizable to pediatric populations.
Purpose of the Study:
- To systematically identify, appraise, and synthesize evidence on p-CESS.
- To provide a foundation for quality evaluation and minimum standards for p-CESS.
- To address the gap in knowledge regarding pediatric clinical ethics support.
Main Methods:
- Mixed-studies systematic review of empirical studies in English/Spanish.
- Searched seven databases (MEDLINE, PsycINFO, etc.) using terms related to "clinical ethics support," "paediatrics," and "structure/process/outcome."
- Employed narrative and thematic synthesis guided by Donabedian's framework; quality assessed with MMAS (2018).
Main Results:
- Evidence synthesis on structures, processes, and outcomes of p-CESS is currently limited.
- The review will identify key characteristics and impacts of existing p-CESS models.
- Data on the evaluation and impact of p-CESS will be systematically compiled.
Conclusions:
- Robust evidence on p-CESS structures, processes, and outcomes is needed.
- This review will inform the development of quality indicators and best practices for p-CESS.
- Findings will guide future research and policy for pediatric clinical ethics support.
Introduction:
Clinical ethics support services (CESS) have been developing worldwide with growing interest in evaluating their quality. Paediatric-specific CESSs (p-CESS) have received little attention, and evidence from adult services might not be generalisable. Evidence on service models and practices is crucial to inform further research and debate on quality evaluation and minimum standards for p-CESSs. We aim to systematically identify, appraise and synthesise evidence for p-CESS structures, processes and outcomes.
Methods And Analysis:
We will conduct a mixed-studies systematic review including peer-reviewed empirical studies published in English or Spanish language providing data on the evaluation and/or impact on any aspect of p-CESS. We will search seven electronic databases: MEDLINE, Philosopher's Index, EMBASE, PsycINFO, LILACS, Web of Science and CINHAL, without filters applied. Search terms will be related to "clinical ethics support" AND "paediatrics" AND "structure/process/outcome". Reference and citation list of included studies will be handsearched. A 10% random sample of retrieved titles/abstracts and all full texts will be independently dual-screened. We will conduct narrative and thematic synthesis for quantitative and qualitative data, respectively, following sequential explanatory synthesis guided by Donabedian's framework of structure, process and outcomes. Quality will be assessed using the Mixed-Methods Appraisal Tool (2018). The review will be reported using the adapted Preferred Reporting Items for Systematic Reviews and Meta-Analyses for reporting systematic reviews of qualitative and quantitative evidence template. Stakeholders will be involved twice in the review process; prior to data extraction and synthesis and after preliminary results.
Ethics And Dissemination:
As a systematic review of published data, no ethical approval is necessary. Results will be published in a relevant academic peer-reviewed journal.
Prospero Registration Number:
CRD42021280978.
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