Evidence map›Paper›PMID 37568138›Full record

ArticleBMC medical ethics2023

Establishing a clinical ethics support service: lessons from the first 18 months of a new Australian service - a case study.

Elizabeth Hoon, Jessie Edwards, Gill Harvey, Jaklin Eliott, Tracy Merlin, Drew Carter, Stewart Moodie, Gerry O'Callaghan

Abstract read
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In one paragraph

Article in BMC medical ethics, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Elizabeth HoonSchool of Public Health, The University of Adelaide, PO Box 5005, Adelaide, SA, 5005, Australia. Elizabeth.Hoon@adelaide.edu.au.
Jessie EdwardsAdelaide Medical School, The University of Adelaide, PO Box 5005, Adelaide, SA, 5005, Australia.
Gill HarveyCollege of Nursing and Health Sciences, Flinders University, PO Box 2100, Adelaide, SA, 5001, Australia.
Jaklin EliottSchool of Public Health, The University of Adelaide, PO Box 5005, Adelaide, SA, 5005, Australia.
Tracy MerlinSchool of Public Health, The University of Adelaide, PO Box 5005, Adelaide, SA, 5005, Australia.
Drew CarterSchool of Public Health, The University of Adelaide, PO Box 5005, Adelaide, SA, 5005, Australia.
Stewart MoodieCentral Adelaide Local Health Network, Adelaide, SA, 5000, Australia.
Gerry O'CallaghanSchool of Public Health, The University of Adelaide, PO Box 5005, Adelaide, SA, 5005, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough the importance of clinical ethics in contemporary clinical environments is established, development of formal clinical ethics services in the Australia health system has, to date, been ad hoc. This study was designed to systematically follow and reflect upon the first 18 months of activity by a newly established service, to examine key barriers and facilitators to establishing a new service in an Australian hospital setting.

methodsHOW THE STUDY WAS PERFORMED AND STATISTICAL TESTS USED: A qualitative case study approach was utilised. The study gathered and analysed data using observations of service committee meetings, document analysis of agendas and minutes, and semi-structured interviews with committee members to generate semantic themes. By interpreting the thematic findings in reference to national capacity building resources, this study also aimed to provide practice-based reflections for other health agencies.

resultsTHE MAIN

findingsAn overarching theme identified in the data was a strong commitment to supporting clinicians facing difficult patient care decisions and navigating difficult discussions with patients and families. Another key theme was the role of the new clinical ethics support service in providing clinicians with a pathway to raise system-wide issues with the organisation Executive. While there was strong clinical engagement, consumer and community participation remained a challenge, as did unresolved governance issues and a need for clearer policy relationship between the service and the organisation. Considering these themes in relation to the national capacity building resources, the study identifies three areas likely to require ongoing development and negotiation. These are: the role of the clinical ethics support service as a link between the workforce and the Executive; the incorporation of consumers and patients; and ethical reasoning. To improve the effectiveness of the service, it is necessary to increase clarity on the service's role at the governance and policy level, as well as develop strategies for engaging consumers, patients and families. Finally, the capacity of the service to reflect on complex cases may be enhanced through explicit discussions of various different ethical frameworks and ways of deliberating.

Indexed as

Delivery of Health CareEthics, ClinicalAustraliaHospitalsHumansCECsClinical ethicsClinical ethics committeesQualitative approach

Identifiers

PMID37568138
PMCPMC10422737

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.