McClimans Leah, Pressgrove Geah, Rhea James
Narrat Inq Bioeth. 2016;6(2):127-142. doi: 10.1353/nib.2016.0019.
The quality of clinical ethics services in health care organizations is increasingly seen as an important aspect of the overall quality of care. But measuring this quality is difficult because there is a lack of clarity and consensus regarding the objectives of clinical ethics and the best outcome domains to measure. The aim of this qualitative study is to explore the views of experts about the objectives and outcomes of clinical ethics services in the US. We interviewed 19 experts in clinical ethics, focusing on the appropriate objectives and outcomes of a clinical ethics service (CES). Participants were selected using a purposive snowball sampling strategy. The development of the interview protocol was informed by the clinical ethics literature as well as by research and theories that inform clinical ethics practice. Interviews were conducted by phone, recorded, and transcribed for individual analysis. Analysis proceeded through the development of a codebook of categories using QDA Miner software. Our experts identified 12 objectives and nine outcomes. Some of these identifications were familiar (e.g., mediation and satisfaction) and some were novel (e.g., be of service and transformation). We found that experts are divided in their emphasis on the kinds of objectives that are most important. In terms of outcomes, our experts were concerned with the appropriateness of different proxy and direct measures. This study provides the perspectives of a select group of experts on the objectives and outcomes appropriate for a CES in the United States. The themes identified will be used in future research to inform a Delphi study to refine and obtain expert consensus.
医疗保健机构中临床伦理服务的质量日益被视为整体护理质量的一个重要方面。但衡量这种质量很困难，因为在临床伦理的目标以及要衡量的最佳结果领域方面缺乏明确性和共识。这项定性研究的目的是探讨美国专家对临床伦理服务的目标和结果的看法。我们采访了19位临床伦理专家，重点关注临床伦理服务（CES）的适当目标和结果。采用目的滚雪球抽样策略选择参与者。访谈协议的制定参考了临床伦理文献以及为临床伦理实践提供信息的研究和理论。通过电话进行访谈，录音并转录以供个人分析。使用QDA Miner软件通过制定类别编码手册进行分析。我们的专家确定了12个目标和9个结果。其中一些识别是常见的（例如，调解和满意度），一些是新颖的（例如，提供服务和转变）。我们发现专家们在对最重要的目标类型的强调上存在分歧。在结果方面，我们的专家关注不同代理和直接测量方法的适当性。这项研究提供了一组特定专家对美国CES合适的目标和结果的观点。所确定的主题将用于未来的研究，为德尔菲研究提供信息，以完善并获得专家共识。
