Flicker Lauren Sydney, Rose Susannah L, Eves Margo M, Flamm Anne Lederman, Sanghani Ruchi, Smith Martin L
Montefiore Einstein Center for Bioethics, Montefiore Medical Center, New York, NY USA.
Cleveland Clinic Department of Bioethics, 9500 Euclid Avenue, JJ60, Cleveland, OH 44195 USA.
J Clin Ethics. 2014 Winter;25(4):281-90.
Checklists have been used to improve quality in many industries, including healthcare. The use of checklists, however, has not been extensively evaluated in clinical ethics consultation. This article seeks to fill this gap by exploring the efficacy of using a checklist in ethics consultation, as tested by an empirical investigation of the use of the checklist at a large academic medical system (Cleveland Clinic). The specific aims of this project are as follows: (1) to improve the quality of ethics consultations by providing reminders to ethics consultants about process steps that are important for most patient-centered ethics consultations, (2) to create consistency in the ethics consultation process across the medical system, and (3) to establish an effective educational tool for trainers and trainees in clinical ethics consultation. The checklist was developed after a thorough literature review and an iterative process of revising and testing by a group of experienced ethics consultants. To pilot test the checklist, it was distributed to 46 ethics consultants. After a six-month pilot period in which ethics professionals used the checklist during their clinical activities, a survey was distributed to all of those who used the checklist. The 10-item survey examined consultants' perceptions regarding the three aims listed above. Of the 25 survey respondents, 11 self-reported as experts in ethics consultation, nine perceived themselves to have mid-level expertise, and five self-reported as novices. The majority (68 percent) of all respondents, regardless of expertise, believed that the checklist could be a "helpful" or "very helpful" tool in the consultation process generally. Novices were more likely than experts to believe that the checklist would be useful in conducting consultations. The limitations of this study include: reduced generalizability given that this project was conducted at one medical system, utilized a small sample size, and used self-reported quality outcome measures. Despite these limitations, to the authors' knowledge this is the first investigation of the use of a checklist systematically to improve quality in ethics consultation. Importantly, our findings shed light on ways this checklist can be used to improve ethics consultation, including its use as an educational tool. The authors hope to test the checklist with consultants in other healthcare systems to explore its usefulness in different healthcare environments.
检查表已被用于提高包括医疗保健在内的许多行业的质量。然而，检查表在临床伦理咨询中的应用尚未得到广泛评估。本文旨在通过探索在伦理咨询中使用检查表的有效性来填补这一空白，这是通过对一个大型学术医疗系统（克利夫兰诊所）使用检查表的实证调查来测试的。该项目的具体目标如下：（1）通过向伦理顾问提供对大多数以患者为中心的伦理咨询重要的流程步骤的提醒，提高伦理咨询的质量；（2）在整个医疗系统中使伦理咨询过程保持一致；（3）为临床伦理咨询的培训人员和学员建立一种有效的教育工具。该检查表是在进行全面的文献综述以及由一组经验丰富的伦理顾问进行反复修订和测试的过程之后制定的。为了对检查表进行试点测试，将其分发给了46名伦理顾问。在为期六个月的试点期间，伦理专业人员在其临床活动中使用了该检查表，之后向所有使用该检查表的人员发放了一份调查问卷。这份包含10个项目的调查问卷考察了顾问们对上述三个目标的看法。在25名调查受访者中，11人自称是伦理咨询专家，9人认为自己具有中级专业知识，5人自称是新手。所有受访者中的大多数（68%），无论专业知识水平如何，都认为检查表在一般咨询过程中可能是一个“有帮助”或“非常有帮助”的工具。新手比专家更有可能认为检查表在进行咨询时会有用。本研究的局限性包括：鉴于该项目是在一个医疗系统中进行的，样本量较小且使用了自我报告的质量结果测量方法，因此普遍性降低。尽管有这些局限性，但据作者所知，这是首次对系统使用检查表以提高伦理咨询质量进行的调查。重要的是，我们的研究结果揭示了该检查表可用于改进伦理咨询的方法，包括将其用作教育工具。作者希望在其他医疗系统中与顾问们一起测试该检查表，以探索其在不同医疗环境中的有用性。
