Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Jul 22;7(7):CD012636.
doi: 10.1002/14651858.CD012636.pub2.

Ethical case interventions for adult patients

Jan Schildmann  1 , Stephan Nadolny, Joschka Haltaufderheide, Marjolein Gysels, Jochen Vollmann, Claudia Bausewein
Affiliations
Review

Ethical case interventions for adult patients

Jan Schildmann et al. Cochrane Database Syst Rev. .

Abstract

Background: Decisions in clinical medicine can be associated with ethical challenges. Ethical case interventions (e.g. ethics committee, moral case deliberation) identify and analyse ethical conflicts which occur within the context of care for patients. Ethical case interventions involve ethical experts, different health professionals as well as the patient and his/her family. The aim is to support decision-making in clinical practice. This systematic review gathered and critically appraised the available evidence of controlled studies on the effectiveness of ethical case interventions.

Objectives: To determine whether ethical case interventions result in reduced decisional conflict or moral distress of those affected by an ethical conflict in clinical practice; improved patient involvement in decision-making and a higher quality of life in adult patients. To determine the most effective models of ethical case interventions and to analyse the use and appropriateness of the outcomes in experimental studies.

Search methods: We searched the following electronic databases for primary studies to September 2018: CENTRAL, MEDLINE, Embase, CINAHL and PsycINFO. We also searched CDSR and DARE for related reviews. Furthermore, we searched Clinicaltrials.gov, International Clinical Trials Registry Platform Search Portal and conducted a cited reference search for all included studies in ISI WEB of Science. We also searched the references of the included studies.

Selection criteria: We included randomised trials, non-randomised trials, controlled before-after studies and interrupted time series studies which compared ethical case interventions with usual care or an active control in any language. The included population were adult patients. However, studies with mixed populations consisting of adults and children were included, if a subgroup or sensitivity analysis (or both) was performed for the adult population.

Data collection and analysis: We used standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care review group. We used meta-analysis based on a random-effects model for treatment costs and structured analysis for the remaining outcomes, because these were heterogeneously reported. We used the GRADE approach to assess the certainty of the evidence.

Main results: We included four randomised trials published in six articles. The publication dates ranged from 2000 to 2014. Three studies were conducted in the USA, and one study in Taiwan. All studies were conducted on intensive care units and included 1165 patients. We judged the included studies to be of moderate or high risk of bias. It was not possible to compare different models of the intervention regarding effectiveness due to the diverse character of the interventions and the small number of studies. Included studies did not directly measure the main outcomes. All studies received public funding and one received additional funding from private sources.We identified two models of ethical case interventions: proactive and request-based ethics consultation. Three studies evaluated proactive ethics consultation (n = 1103) of which one study reported findings on one key outcome criterion. The studies did not report data on decisional conflict, moral distress of participants of ethical case interventions, patient involvement in decision-making, quality of life or ethical competency for proactive ethics consultation. One study assessed satisfaction with care on a 5-point Likert scale (1 = lowest rating, 5 = highest rating). The healthcare providers (nurses and physicians, n = 365) scored a value of 4 or 5 for 81.4% in the control group and 86.1% in the intervention group (P > 0.05). The patients or their surrogates (n = 275) scored a value of 4 or 5 for 83.6% in the control group and for 74.8% in the intervention group (P > 0.05). It was uncertain whether proactive ethics consultation led to high satisfaction with care, because the certainty of evidence was very low.One study evaluated request-based ethics consultation (n = 62). The study indirectly measured decisional conflict by assessing consensus regarding patient care. The risk (increase in consensus, reduction in decisional conflict) increased by 80% as a result of the intervention. The risk ratio was 0.20 (95% confidence interval 0.09 to 0.46; P < 0.01). It was uncertain whether request-based ethics consultation reduced decisional conflict, because the certainty of evidence was very low. The study did not report data on moral distress of participants of ethical case interventions, patient involvement in decision-making, quality of life, or ethical competency or satisfaction with care for request-based ethics consultation.

Authors' conclusions: It is not possible to determine the effectiveness of ethical case interventions with certainty due to the low certainty of the evidence of included studies in this review. The effectiveness of ethical case interventions should be investigated in light of the outcomes reported in this systematic review. In addition, there is need for further research to identify and measure outcomes which reflect the goals of different types of ethical case intervention.

PubMed Disclaimer

Conflict of interest statement

CB: none known.

MG: none known.

JH: none known.

JS: none known.

JV: none known.

SN: none known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Proactive ethics consultation versus usual care, outcome: 1.1 Treatment costs for patients who died in the hospital.
5
5
Forest plot of comparison: 1 Ethical case intervention versus usual care, outcome: 1.2 Mortality.
1.1
1.1. Analysis
Comparison 1 Ethical case intervention versus usual care, Outcome 1 Treatment costs for patients who died in the hospital (USD 1000).
1.2
1.2. Analysis
Comparison 1 Ethical case intervention versus usual care, Outcome 2 Mortality.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Andereck 2014 {published data only}
    1. Andereck WS, McGaughey JW, Schneiderman LJ, Jonsen AR. Seeking to reduce nonbeneficial treatment in the ICU. Critical Care Medicine 2014;42(4):824‐30. [DOI: 10.1097/CCM.0000000000000034] - DOI - PubMed
Chen 2014 {published data only}
    1. Chen YY, Chu TS, Kao YH, Tsai PR, Huang TS, Ko WJ. To evaluate the effectiveness of health care ethics consultation based on the goals of health care ethics consultation. BMC Medical Ethics 2014;15:1. [DOI: 10.1186/1472-6939-15-1] - DOI - PMC - PubMed
Schneiderman 2000 {published data only}
    1. Schneiderman LJ, Gilmer T, Teetzel HD. Impact of ethics consultations in the intensive care setting. Critical Care Medicine 2000;28(12):3920‐4. [DOI: 10.1097/00003246-200012000-00033] - DOI - PubMed
Schneiderman 2003 {published data only}
    1. Cohn F, Goodman‐Crews P, Rudman W, Schneiderman LJ, Waldman E. Proactive ethics consultation in the ICU. A comparison of value perceived by healthcare professionals and recipients. Journal of Clinical Ethics 2007;18(2):140‐7. - PubMed
    1. Gilmer T, Schneiderman LJ, Teetzel H, Blustein J, Briggs K, Cohn F, et al. The costs of nonbeneficial treatment in the intensive care setting. Health Affairs 2005;24(4):961‐71. [DOI: 10.1377/hlthaff.24.4.961] - DOI - PubMed
    1. Schneiderman LJ, Gilmer T, Teetzel HD, Dugan DO, Blustein J, Cranford R, et al. Effect of ethics consultations on nonbeneficial life‐sustaining treatments in the intensive care setting. JAMA 2003;290(9):1166‐72. [DOI: 10.1001/jama.290.9.1166] - DOI - PubMed

References to studies excluded from this review

Agency for Healthcare Research and Quality 2003 {published data only}
    1. Agency for Healthcare Research and Quality (AHRQ). Ethics consultations can help resolve conflicts that may prolong unwanted or nonbeneficial ICU treatments. AHRQ Research Activities 2003;280:6.
Agency for Healthcare Research and Quality 2005 {published data only}
    1. Agency for Healthcare Research and Quality (AHRQ). Ethics consultations can reduce nonbeneficial treatments and costs among dying patients. AHRQ Research Activities 2005;301:23‐24.
Boisaubin 1999 {published data only}
    1. Boisaubin EV, Carter MA. Optimizing ethics services and education in a teaching hospital: rounds versus consultation. Journal of Clinical Ethics 1999;10(4):294‐9. - PubMed
Chromik 2008 {published data only}
    1. Chromik AM, Wemhöner T, Sülberg D, Reploh KG, Laubental H, Uhl W, Mittelkötter U. Interdisciplinary ethics consultation on the surgical intensive care unit [Das interdisziplinäre Ethikkonsil auf der operativen Intensivstation]. Zentralblatt für Chirurgie 2008;133(3):285‐91. [DOI: 10.1055/s-2008-1076825] - DOI - PubMed
Cooke 2001 {published data only}
    1. Cooke M. Ethics consultations in the intensive care unit (ICU) reduced duration of ICU stay and time on aggressive, life sustaining treatments with no change in overall mortality. Evidence Based Nursing 2001;4(4):119. [DOI: 10.1136/ebn.4.4.119] - DOI
Dowdy 1998 {published data only}
    1. Dowdy MD, Robertson C, Bander JA. A study of proactive ethics consultation for critically and terminally ill patients with extended lengths of stay. Critical Care Medicine 1998;26(2):252‐9. - PubMed
Hamel 2006 {published data only}
    1. Hamel R. Ethics committees pursuing enhanced effectiveness. Health Progress 2006;87(2):17.
Heilicser 2000 {published data only}
    1. Heilicser BJ, Meltzer D, Siegler M. The effect of clinical medical ethics consultation on healthcare costs. Journal of Clinical Ethics 2000;11(1):31‐8. - PubMed
Helft 2014 {published data only}
    1. Helft PR. Consultations in Ethics. Oncology 2014;28(9):811‐12. - PubMed
Jones 2004 {published data only}
    1. Jones T. Ethics consultations reduced hospital, ICU, and ventilation days in patients who died before hospital discharge in the ICU. Evidence Based Nursing 2004;7(2):53. [DOI: ] - PubMed
Kamat 2012 {published data only}
    1. Kamat S, Rajendram P, Shuman A, Voigt L, Kostelecky N, McCabe M, et al. A contemporary analysis of ethics consultations in an oncologic icu. Chest 2012;142(4_MeetingAbstracts):759A. [DOI: 10.1378/chest.1389264] - DOI
Katz 2010 {published data only}
    1. Katz MH. Decreasing hospital costs while maintaining quality: can It be done?. JAMA Internal Medicine 2010;170(4):317‐8. [DOI: 10.1001/archinternmed.2009.519] - DOI - PubMed
LaPuma 1995 {published data only}
    1. LaPuma J. Satisfying managed care patients through ethics consultation. Managed Care 1995;4(10):53‐4. - PubMed
Lindon 1996 {published data only}
    1. Lindon JL, Draugalis JR, Iserson KV, Coons SJ. Evaluation of a bioethics committee intervention: a limitation of medical treatment form. HEC Forum 1996;8(3):145‐56. [DOI: 10.1007/BF00115874] - DOI - PubMed
Lueders 1990 {published data only}
    1. Lueders AJ. An evaluation of ethical decision‐making. Journal of the Arkansas Medical Society 1990;86(8):307‐8. - PubMed
McClung 1997 {published data only}
    1. McClung JA. Evaluating an ethics consultation service.. American Journal of Medicine 1997;103(2):167‐8. - PubMed
Miller 1996 {published data only}
    1. Miller J. Ethics case consultation: a study in processes. Massachusetts Nurse 1996;66(9):5.
Nelson 2004 {published data only}
    1. Nelson LJ. Ethics consultations reduce time and procedures in intensive care. Evidence‐Based Healthcare 2004;8(2):63‐4. [DOI: 10.1016/j.ehbc.2004.02.010] - DOI
Nursing Economics Data Bank 2006 {published data only}
    1. Nursing Economics Data Bank. Ethics consultations can reduce nonbeneficial treatments and costs among dying patients. Nursing Economics 2006;24(3):165.
Orr 2009 {published data only}
    1. Orr RD, Shelton W. A process and format for clinical ethics consultation. Journal of Clinical Ethics 2009;20(1):79‐89. - PubMed
Palmer 2004 {published data only}
    1. Palmer K. Doing the right thing. Hospitals ethics committees help clinicians, families, and facilities wrestle with tough questions. A process and format for clinical ethics consultation. Minnesota Medicine 2004;87(6):26‐9. - PubMed
Perkins 1993 {published data only}
    1. Perkins HS, Tolle SW. Evaluation of ethics consultations. American Journal of Medicine 1993;94(1):116. [DOI: 10.1016/0002-9343(93)90137-e] - DOI - PubMed
Perkins 2004 {published data only}
    1. Perkins HS. Ethics consultation reduced hospital, ICU, and ventilation days for ICU patients who died before hospital discharge. ACP Journal Club 2004;140(2):36. - PubMed
Quigley 2003 {published data only}
    1. Quigley 2003. Ethics consultation in the intensive care unit. JAMA 2003;290(24):3191. [DOI: 10.1001/jama.290.24.3191-a] - DOI - PubMed
Ranisch 2016 {published data only}
    1. Ranisch R, Brand C. Clinical ethics consultation and the challenge to implement what Is right. American Journal of Bioethics 2016;16(9):38‐9. [DOI: 10.1080/15265161.2016.1196256] - DOI - PubMed
Relias Media 1999 {published data only}
    1. Relias Media. Ethics can coexist with corporate compliance: integrity approach can be more cost‐effective. Healthcare Risk Management 1999;21(1):6‐11.
Robles 1999 {published data only}
    1. Robles PH. Evaluation of healthcare ethics committees: the experience of an HEC in Spain. HEC Forum 1999;11(3):263‐76. [DOI: 10.1023/A:1008961801026] - DOI - PubMed
Rollins 2003 {published data only}
    1. Rollins G. Ethics consultations reduce futile life‐sustaining treatments. Report on Medical Guidelines and Outcomes Research 2003;14(19):9‐10. - PubMed
Schneiderman 2002 {published data only}
    1. Schneiderman LJ, Gilmer T, Teetzel HD. Ethics consultations in the intensive care setting. Critical Care Medicine 2002;30(2):489. [DOI: 10.1097/00003246-200202000-00041] - DOI - PubMed
Schneiderman 2005 {published data only}
    1. Schneiderman LJ. Ethics consultation in the intensive care unit. Current Opinion in Critical Care 2005;11(6):600‐4. [DOI: 10.1097/01.ccx.0000179933.54508.7a] - DOI - PubMed
Schneiderman 2006 {published data only}
    1. Schneiderman LJ, Gilmer T, Teetzel HD, Dugan DO, Goodman‐Crews P, Cohn F. Dissatisfaction with ethics consultations: the Anna Karenina principle. Cambridge Quarterly of Healthcare Ethics 2006;15(1):101‐6. [DOI: 10.1017/S0963180106060117] - DOI - PubMed
Schwalbe 2007 {published data only}
    1. Schwalbe B. Ethics consultation in the intensive care unit [Ethikberatung auf der Intensivstation]. Journal für Anästhesie und Intensivbehandlung 2007;14(1):188.
Silberman 2007 {published data only}
    1. Silberman J, Morrison W, Feudtner C. Pride and prejudice: how might ethics consultation services minimize bias?. American Journal of Bioethics 2007;7(2):32‐4. [DOI: 10.1080/15265160601109317] - DOI - PubMed
Silen 2015 {published data only}
    1. Silen M, Haglund K, Hansson MG, Ramklint M. Ethics rounds do not improve the handling of ethical issues by psychiatric staff. Nordic Journal of Psychiatry 2015;69(6):418‐25. [DOI: 10.3109/08039488.2014.994032] - DOI - PubMed

Additional references

Ackermann 2016
    1. Ackermann S, Balsiger L, Salathé M. [Ethikstrukturen an Akutspitälern, Psychiatrischen Kliniken und Rehabilitationskliniken der Schweiz. Dritte, erweiterte Umfrage der Schweizerischen Akademie der Medizinischen Wissenschaften]. Bioethica Forum 2016;9(2):52‐9.
Au 2018
    1. Au SS, Couillard P, Roze Ordons A, Fiest KM, Lorenzetti D, Jette N. Outcomes of ethics consultations in adult ICUs: a systematic review and meta‐Analysis. Critical Care Medicine 2018;46(5):799‐808. [DOI: 10.1097/CCM.0000000000002999] - DOI - PubMed
Aulisio 2000
    1. Aulisio MP, Arnold RM, Youngner SJ. Health care ethics consultation: nature, goals, and competencies. A position paper from the Society for Health and Human Values‐Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation. Annals of Internal Medicine 2000;133(1):59‐69. [DOI: 10.7326/0003-4819-133-1-200007040-00012] - DOI - PubMed
Bacchetta 1997
    1. Bacchetta MD, Fins JJ. The economics of clinical ethics programs. A quantitative justification. Cambridge Quarterly of Healthcare Ethics 1997;6(4):451‐60. [DOI: 10.1017/S0963180100008197] - DOI - PubMed
Beca 2010
    1. Beca JP, Koppmann A, Chavez P, Delgado I, Solar S. Analysis of a clinical ethics consultation experience in intensive care [Análisis de una experiencia de consultoría ético clínica en cuidado intensivo]. Revista Médica de Chile 2010;138(7):815‐20. [DOI: 10.4067/S0034-98872010000700004] - DOI - PubMed
Braunack‐Mayer 2001
    1. Braunack‐Mayer AJ. What makes a problem an ethical problem? An empirical perspective on the nature of ethical problems in general practice. Journal of Medical Ethics 2001;27:98‐103. [DOI: 10.1136/jme.27.2.98] - DOI - PMC - PubMed
Chen 2008
    1. Chen YY, Chen YC. Evaluating ethics consultation: randomised controlled trial is not the right tool. Journal of Medical Ethics 2008;34(8):594‐7. [DOI: 10.1136/jme.2007.022277] - DOI - PubMed
Cohn 2007
    1. Cohn F, Goodman‐Crews P, Rudman W, Schneiderman LJ, Waldman E. Proactive ethics consultation in the ICU. A comparison of value perceived by healthcare professionals and recipients. Journal of Clinical Ethics 2007;18(2):140‐7. - PubMed
Corley 2001
    1. Corley MC, Elswick RK, Gorman M, Clor T. Development and evaluation of a moral distress scale. Journal of Advanced Nursing 2011;33(2):250‐6. - PubMed
Covidence [Computer program]
    1. Veritas Health Innovation. Covidence. Melbourne, Australia: Veritas Health Innovation, Accessed 1 September 2018.
Craig 2006
    1. Craig JM, May T. Evaluating the outcomes of ethics consultation. Journal of Clinical Ethics 2006;17(2):168‐80. - PubMed
Detering 2010
    1. Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ 2010;340:c1235. [DOI: 10.1136/bmj.c1345] - DOI - PMC - PubMed
EPOC 2013
    1. Cochrane Effective Practice, Organisation of Care (EPOC). Data collection form. EPOC Resources for review authors. Oslo: Norwegian Knowledge Centre for the Health Services 2013. Available at: epoc.cochrane.org/resources/epoc‐resources‐review‐authors.
EPOC 2015
    1. Cochrane Effective Practice, Organisation of Care (EPOC). Suggested risk of bias criteria for EPOC reviews. EPOC Resources for review authors. Oslo: Norwegian Knowledge Centre for the Health Services 2015. Available at: epoc.cochrane.org/resources/epoc‐resources‐review‐authors.
EPOC 2017a
    1. Cochrane Effective Practice, Organisation of Care (EPOC). Search audit template excel spreadsheet. EPOC Resources for review authors. Oslo: Norwegian Knowledge Centre for the Health Services 2017. Available at: epoc.cochrane.org/resources/epoc‐resources‐review‐authors.
EPOC 2017b
    1. Cochrane Effective Practice, Organisation of Care (EPOC). EPOC worksheets for preparing a summary of findings using GRADE. EPOC Resources for review authors. Oslo: Norwegian Knowledge Centre for the Health Services 2017. Available at: epoc.cochrane.org/resources/epoc‐resources‐review‐authors.
EPOC 2017c
    1. Cochrane Effective Practice, Organisation of Care (EPOC). Worksheet 4: key messages in plain language. EPOC worksheets for preparing a summary of findings using GRADE. EPOC Resources for review authors. Oslo: Norwegian Knowledge Centre for the Health Services 2017. Available at: epoc.cochrane.org/resources/epoc‐resources‐review‐authors.
Fletcher 1996
    1. Fletcher JC, Siegler M. What are the goals of ethics consultation? A consensus statement. Journal of Clinical Ethics 1996;7(2):122‐6. - PubMed
Forde 2011
    1. Forde R, Pedersen R. Clinical ethics committees in Norway. What do they do, and does it make a difference?. Cambridge Quarterly of Healthcare Ethics 2011;20(3):389‐95. [DOI: 10.1017/S0963180111000077] - DOI - PubMed
Fox 1996a
    1. Fox E, Arnold RM. Evaluating outcomes in ethics consultation research. Journal of Clinical Ethics 1996;7(2):127‐38. - PubMed
Fox 1996b
    1. Fox E. Concepts in evaluation applied to ethics consultation research. Journal of Clinical Ethics 1996;7(2):116‐21. - PubMed
Fox 2007
    1. Fox E, Myers S, Pearlman RA. Ethics consultation in United States hospitals: a national survey. American Journal of Bioethics 2007;7(2):13‐25. [DOI: 10.1080/15265160601109085] - DOI - PubMed
Gather 2019
    1. Gather J, Kaufmann S, Otte I, Juckel G, Schildmann J, Vollmann J. Level of development of clinical ethics consultation in psychiatry. Results of a survey among psychiatric acute clinics and forensic psychiatric hospitals [Entwicklungsstand von klinischer Ethikberatung in der Psychiatrie]. Psychiatrische Praxis 2019; Vol. 46, issue 2:90‐6. [DOI: 10.1055/a-0579-6469] - DOI - PubMed
German Medical Association 2006
    1. German Medical Association. [Stellungnahme der Zentralen Kommission zur Wahrung ethischer Grundsätze in der Medizin und ihren Grenzgebieten (Zentrale Ethikkommission) bei der Bundesärztekammer zur Ethikberatung in der klinischen Medizin]. Deutsches Ärzteblatt 2006;103(24):1703‐7.
Gilmer 2005
    1. Gilmer T, Schneiderman LJ, Teetzel H, Blustein J, Briggs K, Cohn F, et al. The costs of nonbeneficial treatment in the intensive care setting. Health Affairs 2005;24(4):961‐71. [DOI: 10.1377/hlthaff.24.4.961] - DOI - PubMed
GRADEpro GDT [Computer program]
    1. McMaster University (developed by Evidence Prime). GRADEpro GDT. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015.
Hajibabaee 2016
    1. Hajibabaee F, Joolaeee S, Cheragh MA, Salari P, Rodney P. Hospital/clinical ethics committees' notion: an overview. Journal of Medical Ethics and History of Medicine 2016;9:17. - PMC - PubMed
Hem 2015
    1. Hem MH, Pedersen R, Norvoll R, Molewijk B. Evaluating clinical ethics support in mental healthcare: a systematic literature review. Nursing Ethics 2015;22(4):452‐66. [DOI: 10.1177/0969733014539783] - DOI - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. [DOI: 10.1136/bmj.327.7414.557] - DOI - PMC - PubMed
Higgins 2011
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Hoffmann 1993
    1. Hoffmann DE. Evaluating ethics committees. A view from the outside. Milbank Quarterly 1993;71(4):677‐701. [DOI: 10.2307/3350425] - DOI - PubMed
Hoffmann 2014
    1. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 2014;348:g1687. [DOI: 10.1136/bmj.g1687] - DOI - PubMed
Huffman 2012
    1. Huffman DM, Rittenmeyer L. How professional nurses working in hospital environments experience moral distress: a systematic review. Critical Care Nursing Clinics of North America 2012;24(1):91‐100. [DOI: 10.1016/j.ccell.2012.01.004] - DOI - PubMed
Hurst 2007
    1. Hurst SA, Perrier A, Pegoraro R, Reither‐Theil S, Forde R, Slowther AM, et al. National surveys on ethics consultation. Journal of Medical Ethics 2007;33(1):51‐7. [DOI: 10.1136/jme.2005.014266] - DOI - PMC - PubMed
JCAHO 2005
    1. Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Comprehensive Accreditation Manual for Hospitals. Oakbrook Terrace (IL): Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 2005.
Kalager 2011
    1. Kalager G, Forde R, Pedersen R. Is the discussion of patient cases in clinical ethics‐committees useful? [Er drøfting av pasientsaker i klinisk etikk‐komiteer nyttig?]. Tidsskr Nor Laegeforen 2011;131(2):118‐21. [DOI: 10.4045/tidsskr.10.0183] - DOI - PubMed
Kaposy 2016
    1. Kaposy C, Brunger F, Maddalena V, Singleton R. Models of ethics consultation used by Canadian ethics consultants: a qualitative study. HEC Forum 2016;28(4):273‐82. [DOI: 10.1007/s10730-015-9299-z] - DOI - PubMed
Kirkham 2010
    1. Kirkham JJ, Dwan KM, Altman DG, Gamble C, Dodd S, Smyth R, et al. The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews. BMJ 2010;340:c365. [DOI: 10.1136/bmj.c365] - DOI - PubMed
Kristjanson 1993
    1. Kristjanson LJ. Validity and reliability testing of the FAMCARE scale: measuring family satisfaction with advanced cancer care. Social Science & Medicine 1993;36(5):693‐701. [DOI: 10.1016/0277-9536(93)90066-D] - DOI - PubMed
La Puma 1988
    1. Puma J, Stocking CB, Silverstein MD, DiMartini A, Siegler M. An ethics consultation service in a teaching hospital. Utilization and evaluation. JAMA 1988;269(6):808‐11. [DOI: 10.1001/jama.1988.03410060078031] - DOI - PubMed
La Puma 1992
    1. Puma J, Stocking CB, Darling CM, Siegler M. Community hospital ethics consultation. Evaluation and comparison with a university hospital service. American Journal of Medicine 1992;92(4):346‐51. [DOI: 10.1016/0002-9343(92)90262-A] - DOI - PubMed
Lamiani 2015
    1. Lamiani G, Borghi L, Argentero P. When healthcare professionals cannot do the right thing: a systematic review of moral distress and its correlates. Journal of Health Psychology 2015;22(1):51‐67. [DOI: 10.1177/1359105315595120] - DOI - PubMed
Landeweer 2011
    1. Landeweer EG, Abma TA, Widdershoven GA. Moral margins concerning the use of coercion in psychiatry. Nursing Ethics 2011;18(3):304‐16. [DOI: 10.1177/0969733011400301] - DOI - PubMed
Liberati 2009
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC. The PRISMA statement for reporting systematic and meta‐analyses of studies that evaluate interventions: explanation and elaboration. PLoS Medicine 2009;6(7):1‐28. [DOI: 10.1371/journal.pmed.1000100] - DOI - PMC - PubMed
Lo 2003
    1. Lo B. Answers and questions about ethics consultations. JAMA 2003;290(9):1208‐10. [DOI: 10.1001/jama.290.9.1208] - DOI - PubMed
Mack 2012
    1. Mack JW, Smith TJ. Reasons why physicians do not have discussions about poor prognosis, why it matters, and what can be improved. Journal of Clinical Oncology 2012;30(22):2715‐7. [DOI: 10.1200/JCO.2012.42.4564] - DOI - PubMed
McCarthy 2015
    1. McCarthy J, Gastmans C. Moral distress: a review of the argument‐based nursing ethics literature. Nursing Ethics 2015;22(1):131‐52. [DOI: 10.1177/0969733014557139] - DOI - PubMed
McClung 1996
    1. McClung JA, Kamer RS, DeLuca M, Barber HJ. Evaluation of a medical ethics consultation service: opinions of patients and health care providers. American Journal of Medicine 1996;100(4):456‐60. [DOI: 10.1016/S0002-9343(97)89523-X] - DOI - PubMed
Melbourne 2010
    1. Melbourne E, Sinclair K, Durand M‐A, Legare F, Elwyn G. Developing a dyadic OPTION scale to measure perceptions of shared decision making. Patient Education and Counseling 2010;78(2):177‐83. [DOI: 10.1016/j.pec.2009.07.009] - DOI - PubMed
Molewijk 2008
    1. Molewijk AC, Abma T, Stolper M, Widdershoven G. Teaching ethics in the clinic. The theory and practice of moral case deliberation. Journal of Medical Ethics 2008;34(2):120‐4. [DOI: 10.1136/jme.2006.018580] - DOI - PubMed
O'Connor 1995
    1. O'Connor AM. Validation of a decisional conflict scale. Medical Decision Making 1995;15(1):25‐30. - PubMed
Oh 2015
    1. Oh Y, Gastmans C. Moral distress experienced by nurses: a quantitative literature review. Nursing Ethics 2015;22(1):15‐31. [DOI: 10.1177/0969733013502803] - DOI - PubMed
Orr 1996
    1. Orr RD, Morton KR, deLeon DM, Fals JC. Evaluation of an ethics consultation service: patient and family perspective. American Journal of Medicine 1996;101:135‐41. [DOI: 10.1016/S0002-9343(96)80067-2] - DOI - PubMed
Pedersen 2010
    1. Pedersen R, Hurst SA, Schildmann J, Schuster S, Molewijk B. The development of a descriptive evaluation tool for clinical ethics case consultations. Clinical Ethics 2010;5(3):136‐41. [DOI: ]
Pfäfflin 2009
    1. Pfäfflin M, Kobert K, Reiter‐Theil S. Evaluating clinical ethics consultation: a European perspective. Cambridge Quarterly of Healthcare Ethics 2009;18(4):406‐19. [DOI: 10.1017/S0963180109090604] - DOI - PubMed
Pope 2011
    1. Pope TM. Legal briefing: healthcare ethics committees. Journal of Clinical Ethics 2011;22(1):74‐93. - PubMed
Reiter‐Theil 2014
    1. Reiter‐Theil S, Schurmann J, Schmeck K. Clinical ethics in psychiatry: state of the art [Klinische Ethik in der Psychiatrie: State of the Art]. Psychiatrische Praxis 2014;41(7):355‐63. [DOI: 10.1055/s-0034-1370058] - DOI - PubMed
Review Manager 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Rogers 2008
    1. Rogers S, Babgi A, Gomez C. Educational interventions in end‐of‐life care: part I: an educational intervention responding to the moral distress of NICU nurses provided by an ethics consultation team. Advances in Neonatal Care 2008;8(1):56‐5. [DOI: 10.1097/01.ANC.0000311017.02005.20] - DOI - PubMed
Royal College of Physicians 2005
    1. Royal College of Physicians of London. Ethics in Practice. Background and Recommendations for Enhanced Support. Report of a Working Party. London (UK): Royal College of Physicians of London, 2005.
Rushton 2013
    1. Rushton CH, Kaszniak AW, Halifax JS. Addressing moral distress: application of a framework to palliative care practice. Journal of Palliative Medicine 2013;16(9):1080‐88. [DOI: 10.1089/jpm.2013.0105] - DOI - PubMed
Salloch 2016
    1. Salloch S, Ritter P, Wäscher S, Vollmann J, Schildmann J. What is an ethical problem and how do I find it? Theoretical, methodological and practical questions to identify ethical problems in an empirical–ethical intervention study [Was ist ein ethisches Problem und wie finde ich es? Theoretische, methodologische und forschungspraktische Fragen der Identifikation ethischer Probleme am Beispiel einer empirisch‐ethischen Interventionsstudie]. Ethik in der Medizin 2016; Vol. 28, issue 4:267‐81. [DOI: 10.1007/s00481-016-0384-x] - DOI
Schildmann 2010
    1. Schildmann J, Vollmann J. Evaluation of clinical ethics consultation: a systematic review and critical appraisal of research methods and outcome criteria. In: Schildmann J, Gordon J‐S, Vollmann J editor(s). Clinical Ethics Consultation: Theories and Methods, Implementation, Evaluation. 1st Edition. Farnham (UK): Ashgate, 2010:203‐15.
Schildmann 2013
    1. Schildmann J, Molewijk B, Benaroyo L, Forde R, Neitzke G. Evaluation of clinical ethics support services and its normativity. Journal of Medical Ethics 2013;39(11):681‐5. [DOI: 10.1136/medethics-2012-100697] - DOI - PubMed
Schildmann 2016
    1. Schildmann J, Nadolny S, Wäscher S, Gysels M, Vollmann J, Bausewein C. Clinical ethics support services (CESS) as complex intervention. Preliminary findings of a conceptual analysis and possible implications for outcomes research. Bioethica Forum 2016;9(2):90‐3.
Schildmann 2019
    1. Schildmann J, Nadolny S, Haltaufderheide J, Gysels M, Vollmann J, Bausewein C. Do we understand the intervention? What complex intervention research can teach us for the evaluation of Clinical Ethics Support Services (CESS). BMC Medical Ethics 2019; Vol. 20:48. [DOI: 10.1186/s12910-019-0381-y] - DOI - PMC - PubMed
Schochow 2015
    1. Schochow M, Schnell D, Steger F. Implementation of clinical ethics consultation in German hospitals. Science and Engineering Ethics 2015 Sep 24 [Epub ahead of print]. [DOI: 10.1007/s11948-015-9709-2] - DOI - PubMed
Slowther 2012
    1. Slowther AM, McClimans L, Price C. Development of clinical ethics services in the UK: a national survey. Journal of Medical Ethics 2012;38(4):210‐4. [DOI: 10.1136/medethics-2011-100173] - DOI - PubMed
Steinkamp 2007
    1. Steinkamp N, Gordijn B, Borovecki A, Gefenas E, Glasa J, Guerrier M, et al. Regulation of healthcare ethics committees in Europe. Medicine, Health Care, and Philosophy 2007;10(4):461‐75. [DOI: 10.1007/s11019-007-9054-6] - DOI - PMC - PubMed
Strech 2010
    1. Strech D, Hurst S, Danis M. The role of ethics committees and ethics consultation in allocation decisions. A 4‐stage process. Medical Care 2010;48(9):821‐6. [DOI: 10.1097/MLR.0b013e3181e577fb] - DOI - PMC - PubMed
Strätling 2013
    1. Strätling MW, Sedemund‐Adib B. Therapy limitations in intensive care medicine [Therapiebegrenzung in der Intensivmedizin]. Der Anaesthesist 2013;62(6):489‐90. [DOI: 10.1007/s00101-013-2187-5] - DOI - PubMed
Swiss Academy of Medical Sciences 2012
    1. Swiss Academy of Medical Sciences. Ethics Support in Medicine. www.samw.ch (accessed 1 March 2019).
Tanner 2014
    1. Tanner S, Albisser‐Schleger H, Meyer‐Zehnder B, Schnurrer V, Reiter‐Theil S, Pargger H. Clinical everyday ethics‐support in handling moral distress? Evaluation of an ethical decision‐making model for interprofessional clinical teams [Klinische Alltagsethik – Unterstützung im Umgang mit moralischem Disstress? Evaluation eines ethischen Entscheidungsfindungsmodells für interprofessionelle klinische Teams]. Medizinische Klinik, Intensivmedizin und Notfallmedizin 2014;109(5):354‐63. [DOI: 10.1007/s00063-013-0327-y] - DOI - PubMed
Tarzian 2013
    1. Tarzian AJ, ASBH Core Competencies Update Task Force. Health care ethics consultation: an update on core competencies and emerging standards from the American Society for Bioethics and Humanities' Core Competencies Update Task Force. American Journal of Bioethics 2013;13(2):3‐13. [DOI: 10.1080/15265161.2012.750388] - DOI - PubMed
Tulsky 1996
    1. Tulsky JA, Fox E. Evaluating ethics consultation: framing the questions. Journal of Clinical Ethics 1996;7(2):109‐15. - PubMed
Wan 2014
    1. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Medical Research Methodology 2014;14:135. [DOI: 10.1186/1471-2288-14-135] - DOI - PMC - PubMed
Ware 2001
    1. Ware JE Jr. SF‐36 Physical and Mental Health Summary Scales: a Manual for Users of Version 1. 2nd Edition. Lincoln: Quality Metric Inc, 2001.
Wenger 2002
    1. Wenger N, Golan O, Shalev C, Glick S. Hospital ethics committees in Israel: structure, function and heterogeneity in the setting of statutory ethics committees. Journal of Medical Ethics 2002;28(3):177‐82. [DOI: ] - PMC - PubMed
White 1993
    1. White BD, Zaner RM, Bliton MJ, Hickson GB, Sergent JS. An account of the usefulness of a pilot clinical ethics program at a community hospital. Quality Review Bulletin 1993;19(1):17‐24. [DOI: 10.1016/S0097-5990(16)30583-8] - DOI - PubMed
Whitehead 2009
    1. Whitehead JM, Sokol DK, Bowman D, Sedgwick P. Consultation activities of clinical ethics committees in the United Kingdom: an empirical study and wake‐up call. Postgraduate Medical Journal 2009;85(1007):451‐4. [DOI: 10.1136/pgmj.2008.075879] - DOI - PubMed
Williamson 2007
    1. Williamson L. Empirical assessments of clinical ethics services. Implications for clinical ethics committees. Clinical Ethics 2007;2(4):187‐92. [DOI: 10.1258/147775007783560184] - DOI - PMC - PubMed

References to other published versions of this review

Schildmann 2017
    1. Schildmann J, Nadolny S, Haltaufderheide J, Gysels M, Vollmann J, Bausewein C. Ethical case interventions for adult patients. Cochrane Database of Systematic Reviews 2017, Issue 4. [DOI: 10.1002/14651858.CD012636] - DOI - PMC - PubMed

LinkOut - more resources