Table 2 Study characteristics
From: Clinical ethics consultations: a scoping review of reported outcomes
Location | Setting | Study design | Study period | Population | Sample size (N =) | Reference # |
|---|---|---|---|---|---|---|
United States | 1 medical/surgical ICU at a large, tertiary, not-for-profit medical center | Prospective randomized exploratory trial | October 2007 to February 2010 (28 months) | English-speaking adult patients received treatment in the medical/surgical ICU for at least 5 days | 384 (Intervention N = 174, Control N = 210) | [48] |
Norway | 9 different hospitals from six different locations in Norway | Qualitative Study | 2006–2009 (36 months) | Doctors who had referred EOL decision to a CEC, or has been a member of a medical team who requested CEC assistance | 15 | [49] |
Sweden | 1 publicly funded children's hospital in Sweden | Qualitative Study | Not indicated | Healthcare professionals (physicians, nurses, nurse assistants, psychologist, and play therapists) working at hospital | 6 ECR sessions observed, 35 healthcare professionals in the six ECR sessions; 10 healthcare professionals were individually interviewed outside of the ECR sessions | [50] |
United States | large tertiary care facility that is both a community hospital and a major academic medical center | Quality Improvement | July 1–December 31 in 2011 and 2013 (10 months total) | Nurses who requested CEC | 15 | [51] |
Chile | ICU at a private clinic in Santiago, Chile | Quality Improvement | Not indicated | Intensivist Physicians | 26 | [52] |
United States | 562 bed academic hospital | Quality Improvement | 2011–2012 (12 months) | Staff, students, patients, families | 184 | [53] |
Sweden | integrated heart-failure and specialist palliative in-home programme at Palliative Advanced Homecare and Heart Failure Care | Qualitative, descriptive study | Only indicates year May 2013 | PREFER team (specialized care team) consisting of physicians (1 cardiologist, one GP specializing in palliative medicine), RNs (2 district nurses one heart failure palliative care nurse), OT (1), and physiotherapist (1) | 7 | [54] |
United States | Adult ICUs of 7 US hospitals selected to represent a broad spectrum of characteristics, including community, religious, managed care, and academic institutions with diverse patient populations. All have busy ICUs and active CECs | Mixed methods | Not indicated | Healthcare providers and patients/surrogates/family members who were identified as potentially having a values conflict | 363 (N = 108 family members, N = 255 HCPs) | [55] |
United States | 600-bed academic hospital in a large metropolitan city in the MidWest | Qualitative Study | Not Indicated | Healthcare professionals representing multiple areas of the hospital and consisted of nurses, physicians, and social workers | 16 | [56] |
United States | Cleveland Clinic Foundation | Quality Improvement | August 1985–April 1992 (~ 80 months) | Family members and staff involved in the consultation | 26 (N = 6 family members, N = 40 staff members) | [57] |
Netherlands | Neonatal intensive care unit of a pediatric teaching hospital in the Netherlands | Quality Improvement | Not indicated | Multidisciplinary healthcare professionals (physician, nurse, nurse practitioners, social worker, pastor) involved in the MEDM (medical ethical decision-making) | 105 | [58] |
Sweden/Norway/Netherlands | Community care, somatic hospital care, psychiatry, care for mentally disabled, Dutch health inspectorate, and hospital policy departments | Descriptive Longitudinal field survey and psychometric testing | Not indicated | Nurses (RNs, Support Workers, Psychosocial Workers), Nurse Assistants, Doctors/Specialists/Psychiatrists, Therapists (Physiotherapists, Psychologist, Spiritual Caregivers, and Social Workers), Managers (Department Heads and Policy Makers), and Others (Volunteers, Clients, Researchers, Trustees, Secretary's and Interns) | 443 HCPs participating in 4 MCDs across 30 institutions (Sweden = 6, Netherlands = 10, Norway = 14) (T1) 247 HCP's participating in 8 MCDs across 25 institutions (Sweden = 6, Netherlands = 5, Norway = 14) (T2) | [59] |
United States | ICU for terminally ill/critically ill patients at Hospital in the US | Prospective, controlled group design study | June 1992–October 1994 (28 months) | ICU patients treated with > 96 continuous mechanical ventilation | 99 | [60] |
United States | Nonprofit tertiary hospital in Los Angeles | Retrospective analysis; quality | July 1–December 31 in 2011 and 2013 (10 months total) | Members of clinical team who requested consultation (i.e. physician, social worker, and nurse) | 91 questionnaires completed by 58 individuals | [61] |
Norway | Norwegian Hospitals (Number Unspecified) | Qualitative study | Period not indicated; study began in May 2004 | Clinicians who had brought cases to the ethics committees for case consultation | 8 | [62] |
Japan | Japan; as the first clinical ethics service in Japan, informed general public of service thru mass media and team's medical institution affiliations in Japan | Quality Improvement | October 2006–December 2007 (14 months) | Medical practitioners | 25 consultations; 22 of which were requests from medical practitioners (N = 18 responses received) | [63] |
United States | 6 hospitals | Randomized Control Trial | 2000–2002 (24 months) | Patients in adult intensive care unit | 499 (of 551 study patients); intervention (n = 252) vs control (n = 247) | [64] |
Taiwan | 3 surgical intensive care units in Hospital | Randomized control trial | Not indicated | Patients in surgical intensive care units with "medical uncertainty/conflict regarding value-laden issues" | 62 patients (33 randomly assigned to HCEC group; 29 randomly assigned to UC group) | [65] |
Australia | Centre for Children's Health Ethics and Law (CCHEL); situated within a 359-bed, tertiary-quaternary pediatric hospital | Quality Improvement | Referrals from February 2015-January 2017. Design proceeded in three phases over a study period of 24Â months | Healthcare staff (consultant medical officers, nurses, allied healthcare professionals, advanced trainee medical officers, social workers) | 35 responses from 11 cases | [66] |
Netherlands | Dutch organization for aged care in the south of Netherlands consists of 20 care centres | Mixed Method Evaluation study | Period not indicated; study occurred in 2009 | Nursing caregivers of different educational levels, motivational therapists, dietitians, team leaders | 61 moral case deliberation (MCD) sessions organized in 16 care centres; 493 questionnaires returned (team leaders N = 43, professional caregivers N = 450); 5 in-depth interviews and 3 focus groups | [67] |
United States | 712-bed community teaching hospital with 700 member private medical staff | Prospective Study | January 1, 1988–December 31, 1989 (12 months) | Requesting physicians and patients referred for consultation | 104 requests; 83 physicians participated (80%); 104 patients | [68] |
United States | University teaching hospital | Prospective study | Period of evaluation July 1, 1986 to June 2, 1987 (11Â months) | Requesting physicians and patients referred for consultation | 51 requests; 45 physicians | [69] |
Germany | Large German general hospital with over 1700 beds and 26 specialized clinical departments | Observational study | January 2006-June 2015 (~ 103 months) | Adult inpatients in 3 inpatient settings: ICU, low care units, psychiatric care | 259 CECs (ICU 43.6%, low care units 33.6%, psychiatric care units 22.8%) | [70] |
Canada | No information about clinical setting; all participants were from Toronto, Canada | Qualitative | Not indicated | Family caregivers involved in making care and treatment decisions for a hospitalized family member at the end of life | 20 (12 women, 8 men; 2 from the same family); only 5 participants used the services of the clinical ethicist during their decision-making process | [71] |
Norway | Community Health and Care Settings | Quality Improvement | January–March 2015 (1st survey) and April- September 2015 (2nd survey(7 months) | Municipal contact persons for the ethics project (ethics activities implemented in the health and care sector in more than 200 municipalities), and ethics facilitators | 137 (municipal contact persons); 217(ethics facilitators) | [72] |
Norway | 19 Norwegian Hospitals | Prospective questionnaire (Mixed Method) | September 2016–2017 (12 months) | Clinicians, patients, next of kin, managers, patient ombudsman, CEC members | 61 | [73] |
United States | 476-bed teaching hospital and tertiary referral center of New York Medical College | Quality Assurance (Quality Improvement) | January 1990-December 1992 (24Â months) | Physicians, nurses, patients, family members who were associated with 20 sequential cases referred to CEC | 61 (24 physicians; 20 nurses; 17 patients or family members) regarding 20 consultations in a two-year period | [74] |
United States | Suburban community hospital | Economic Analysis | July-December 1994 (5Â months) | Economic analysis of 29 patient cases/consultations | 29 | [75] |
Netherlands | Academic psychiatric hospital | Quality Improvement | 4Â year project (48Â months) | Participants of MCD sessions (e.g., nurse, psychologist/therapist, physician, manager/chief, other occupation) | 69 | [76] |
United States | Department of Family Medicine at 625-bed tertiary care teaching hospital | Retrospective design (medical chart review) and physician evaluation | August 1, 1990–July 31, 1991 (12 months) | Requesting physicians | 43 attending physicians | [77] |
United States | Department of Family Medicine 625-bed tertiary care teaching hospital | Prospective study | February 1, 1994–January 31 1995 (12 months) | Patients, caregivers (parents, spouses, adult sons/daughters, siblings, other family member, friends) | 56 interviews with patients or their surrogates (caregivers) | [78] |
United States | University of Texas Health Science Center at San Antonio—includes a 630 bed county hospital and 700-bed Veterans Administration hospital | Prospective study and retrospective design | 18 month period (January 1984- June 1985) | Physicians who requested consultations | 24 (physician requestors) regarding 44 consultation | [79] |
Germany | University hospital | Nonparticipating observation of consultations (prospective and retrospective) and subsequent qualitative evaluation | Not identified | Ethicists, physicians, nurses, psychologists | 28 interviews and 14 observations | [80] |
United States | Medical and pediatric ICUs in a university medical center | Prospective, randomized controlled intervention trial | February 1997–October 1998 (20 months) | Patients in whom value-based treatment conflicts arose during the course of treatment; healthcare providers and family members involved with the 23 intervention patients who had received ethics consultation | N = 70 (CEC group n = 35; UC = 35); Interviews, N = 55; n = 47 providers (28 medical doctors, 14 registered nurses, 3 social workers, 1 managed care representative, 1 chaplain), n = 8 family members | [81] |
United States | Adult ICUs of 7 hospitals across the US | Multi-centre prospective randomized controlled intervention trial | November 2000–December 2002 (24 months) | Adult patients in whom value-related treatment conflicts arose during the course of treatment that could lead to incompatible courses of action; interviews with nurses, physicians, patients or surrogates who received ethics consultations | N = 551 (CEC group n = 278; UC = 273); Interviews, N = 383 (n = 272 nurses and physicians, n = 111 patients and surrogates—2 pts, 109 surrogates) | [82] |
Sweden | Psychiatric outpatient clinics in a county in Sweden | Qualitative study (exploratory/descriptive design)—content analysis | Not identified | Healthcare personnel (working in 2 different psychiatry outpatient clinics with experience of participating in ethics rounds) | 11 | [83] |
United States | The Cleveland Clinic Foundation | Quality Improvement | Period not identified, study began in Spring 1990 | Health professionals who deal directly with patients and families and who are called upon to make decisions regarding appropriate patient care | 794 (n = 213 staff physicians, n = 176 resident physicians, n = 370 nurses, n = 26 social workers, n = 9 pastoral care staff) [46% of respondents had used the Dept of Bioethics—consult service for the purposes of this scoping review] | [84] |
United States | Medical-surgical ICU at a comprehensive 470-bed academic cancer center in New York City | Retrospective design (using ICU, hospital, and ethics databases) | September 2007–December 2011 (51 months) | Adult patients with cancer who were admitted to the ICU and who had an ethics consultation | 53 | [85] |
Netherlands | Large mental health care institution | Mixed method (responsive evaluation method through dialogue with stakeholders) structured interviews and semi-structured questionnaire conducted after request received before start of the session and subsequent evaluation questionnaire after MCD Likert scale and open ended questions) | April 2008–April 2011 (36 months) | Managers and nurses | 78 (Pre Session) and 255 (Post MCD) | [86] |
United States | Nine critical and special care units at Saint Thomas Hospital in Nashville, TN—a 670 bed adult acute-care facility and a teaching hospital affiliated with a university medical center | Qualitative survey | Did not indicate | Clinical ethicist, nurses and physicians involved in the individualized CEC (the clinical ethicist participated in self-evaluation) | 88 (n = 37 ethicists, n = 23 nurses, n = 28 physicians) | [87] |
United States | 350-bed university-affiliated community hospital in Portland, OR | Mixed Method | 1993–1995 (24 months) | CEC requestors (requests were made by attendings, consultants, residents, nurses, ancillary staff, hospital administrators, medical staff committees) | 45 | [47] |
United States | Single-site 900 + bed academic medical centre with a dedicated ECMO programme | Mixed Method (retrospective review of EC documentation and semi-structured interview) | August 15, 2018 to May 15, 2019 (9 months) | Clinicians caring for patients on ECMO | Interviews N = 20 Chart Review N = 68 | [88] |
United States | PICU in a quaternary care children's hospital; PICU has 26 beds | Pre/post design and using retrospective historical controls | Does not indicate | Physicians and nurses on staff in the pediatric intensive care unit; patients were identified for PEACE round discussions and historical controls | N = 126 patient cases (n = 60 CEC group, n = 66 historical control group); N = 42 ( n = 32 nurses and n = 10 physicians) completed the pre/post survey | [89] |
United States | Single large academic healthcare system in the Midwest that includes two urban adult hospitals and one pediatric hospital | Survey and qualitative interview | Does not indicate | Healthcare professionals involved in the care of a patient who was the focus of a CEC, hc professionals who initiated a CEC, or who were present at a patient care conference attended by an ethics consultant | N = 115 professionals completed the survey; N = 48 interviews (n = 9 social workers, n = 22 nurses, n = 17 physicians), representing 13 consultations | [90] |
United States | Pediatric teaching hospital | Retrospective chart review and structured interviews (5-point Likert scale and open ended narrative) | September 4, 1990-April 10, 1995 (55 months) | Pediatric ethics consultations; physicians, social workers, family members | N = 35 pediatric ethics consultations (chart review); n = 23 physicians or social workers, n = 4 family members, involved with 23 of the consultations (interview survey) | [91] |
Sweden | University hospital (peritoneal dialysis and dialysis), general hospital (medical assessment unit), community hospital (internal medicine, dialysis, geriatric cardiology), and municipalities (rehab, short-term care) | Explorative qualitative interview study utilizing semi-structured interview | Not identified | First-line managers | 11 | [92] |
Netherlands | 2 transgender clinics offering gender affirming medical treatment (clinic at the Centre of Expertise for Gender Dsymorphia at the Amsterdam University Medical Centre; clinic at Curium-Leiden University Medical Center) | Mixed Method (qualitative interviews, focus groups and questionnaire that includes a 26 item survey and open ended questions) | Not identified | Specialists in child and adolescent psychiatry and psychology, endocrinology, pediatric endocrinology, surgeons and gynecologists | N = 6 MCD sessions were audiotaped & analyzed; N = 6 individual interviews with MCD participants; N = 2 focus groups (15 participants total); N = 34 (Pre-Session) N = 22 (Post-MCD) questionnaire | [93] |
United States | A large, tertiary academic medical centre | Qualitative interview study | May 2020 to July 2020 | Healthcare professionals (physicians, nurses, social workers, etc.) involved in an ethics consult between March 11, 2020 and May 6, 2020 | 14 | [94] |