Table 4 Outcome domain reporting
From: Clinical ethics consultations: a scoping review of reported outcomes
Outcome domain | Subthemes identified | Subtheme descriptors (thematic summary of measures and outcomes) | # of Studies | Reference #’s |
|---|---|---|---|---|
Quality | Overall Experience | Participants' perception of the quality of their overall experience of the intervention as a whole, or the facilitator of the intervention including whether such was positive or negative, what the perceived benefit or purpose of the intervention/deliverer was, if they were satisfied overall, the experience of patient/next of kin involvement, and general recommendations for improvement | 6 | |
Effectiveness | Participants experience of benefit of involvement in the intervention and/or their agreement or disagreement with the ability and degree of the intervention to meet aims/measured of quality and efficacy | 2 | ||
Usefulness | Evaluation of the practical value of the intervention including the extent to which goals are met during the intervention, whether the outcomes or results are helpful to participants, or ways in which participants appreciated the consultation or understood its purpose for their roles | 16 | [55, 57, 61, 63, 67,68,69, 73, 74, 76,77,78, 80, 81, 84, 91] | |
Satisfaction | Participants satisfaction with either the overall experience or a particular constituent of the intervention for current practice, and for the future of practice including whether they themselves would seek out CEC again or recommend it to others, the ability for the intervention to meet its actual or perceived aims and purpose(s), the amount of agreement/consensus between stakeholders, or their overall impression of the intervention | 11 | ||
Ability to Better Practice | The ability of the intervention to improve or better practice including the betterment of practice as a whole, or improvement in patient care, handling of ethical dilemmas, employee cooperation, service quality, relationships with stakeholders, and/or work environment | 1 | [72] | |
Personal | Clarity | Did the stakeholder experience a change in the clarity of ethical issues | 1 | [79] |
Moral Distress | Did the recipient experience an impact of acute moral distress after the intervention | 2 | ||
Confidence | Did participants (physicians) experience an increase in confidence in the final plan | 1 | [79] | |
Learning | How much did participants perceive to have been taught or learned | 2 | ||
Perceived Value/Outcomes | What was the perceived value for self and for individual practice, impact on values, perspective and/or whether stakeholders experienced any outcomes at all during the session or in their practice | 3 | ||
Experience | What was the general use to recipients of CEC, and whether the intervention met expectations, and in what ways did the intervention allow recipients to meet in an ethical “free-zone” | 2 | ||
Process | Consensus/Integration | Whether the intervention achieved consensus between or within stakeholder groups, including whether groups followed recommendations, whether options or goals of care were agreed upon at the end of consultation, whether individuals generated common care goals, and whether familial perspectives were integrated into decision making | 3 | |
Adherence | The ability of the service/deliverers to adhere to service-level standards for stakeholders and whether such improved staff competency to adhere to guidelines | 1 | [66] | |
Purpose/Impact | What was the perceived purpose or impact of the intervention on stakeholders, including the impact on their expectation of service, what the perceived outcomes were, including whether it clarified ethical issues, educated, increased confidence, facilitated decisions, whether the process was consistent with goals, respected values, resolved issues, created cooperation, developed critical attitudes, empowered, enhanced, provided understanding, boundaries, facilitated quality care, and explored policy, paradigms, and vision. Studies also examined what particular actions the intervention took to serve stakeholders | 14 | ||
Identification | Did consultants identify issues not seen by requestors | 1 | [79] | |
Advancing Care | Did the intervention assist in or facilitate transitioning the patient out of hospital | 1 | [56] | |
Helpfulness | The impact of the intervention on practice including its ability to assist in identifying, analyzing and resolving issues, educating stakeholders, facilitating discussion and sharing of personal views, and whether it was perceived to have a positive impact on the case at hand | 2 | ||
Support | Was the intervention perceived to facilitate support for interpersonal relationships and interactions among staff, family, and patients | 1 | [51] | |
Clarification | Did the intervention enhance ethical reflection, increase interprofessional understanding, better ground decisions, or increase unity among stakeholders | 1 | [50] | |
Clinical | Consensus | Was there consensus regarding recommendation or agreement on goals of care | 2 | |
Patient Management and Provision of Care | Did the intervention impact the amount or kind of care patients received including the presence of orders/decisions (DNR, withholding/withdraw orders, life-sustaining treatment, limits of care, requests for spiritual care, social services, and pain management), the provision of palliative care or chaplaincy services, and whether there was agreement with the decision, a change in treatment plan or a change in patient management post-intervention | 11 | ||
Quality of Care | Was there a tangible improvement in the quality of patient care | 1 | [89] | |
Coercion | Does CEC lead to lesser use of coercion | 1 | [72] | |
Nonbeneficial Care | Did CEC impact the use or degree of use of “non beneficial care” including impact to the number of days in hospital or ICU specifically, or the number of patients using life-sustaining treatment in those who died before discharge | 3 | ||
Suffering | What was the amount of perceived patient suffering from provider/patient/surrogate perspective pre and post intervention | 1 | [48] | |
Mortality | Did CEC increase/decrease patient mortality, the number of patients that died in hospital, or discharge status (dead/alive) | 3 | ||
Resource | Length of Stay/Resource Consumption | Assessment of CEC intervention impact on length of stay or number of inpatient days in hospital or ICU specifically | 4 | |
Cost | Impact to overall patient-specific, departmental, or organizational cost including the total cost of stay, net cost of consultation, or impact to charges for patients | 3 | ||
Cost Avoidance | Expenses that were avoided or added for patients who received consultation, and the total cost avoidance given intervention | 1 | [75] |