Ruhr-University Bochum, Germany.
Bielefeld University of Applied Sciences, Germany; Martin Luther University Halle-Wittenberg, Germany; University of Applied Sciences for Diakonia, Germany.
Nurs Ethics. 2020 May;27(3):838-854. doi: 10.1177/0969733019878840. Epub 2019 Nov 19.
Clinical ethics support services have been advocated in recent decades. In clinical practice, clinical ethics support services are often requested for difficult decisions near the end of life. However, their contribution to improving healthcare has been questioned and demands for evaluation have been put forward. Research indicates that there are considerable challenges associated with defining adequate outcomes for clinical ethics support services. In this systematic review, we report findings of qualitative studies and surveys, which have been conducted to evaluate clinical ethics support services near the end of life.
Electronic databases and other sources were queried from 1970 to May 2018. Two authors screened studies independently. Methodological quality of studies was assessed. For each arm of the review, an individual synthesis was performed. Prospero ID: CRD42016036241.
Ethical approval is not needed as it is a systematic review of published literature.
In all, 2088 hits on surveys and 2786 on qualitative studies were found. After screening, nine surveys and four qualitative studies were included. Survey studies report overall positive findings using a very wide and heterogeneous range of outcomes. Negative results were reported only occasionally. However, methodological quality and conceptual justification of used outcomes was often weak and limits generalizability of results.
Evidence points to positive outcomes of clinical ethics support services. However, methodological quality needs to be improved. Further qualitative or mixed-method research on evaluating clinical ethics support services may contribute to the development of evaluating outcomes of clinical ethics support services by means of broaden the range of appropriate (process-oriented) outcomes of (different types of) clinical ethics support services.
近年来，临床伦理支持服务一直受到提倡。在临床实践中，常常需要临床伦理支持服务来协助处理临近生命终点的艰难决策。然而，其对改善医疗保健的贡献一直受到质疑，并提出了评估的要求。研究表明，为临床伦理支持服务定义充分的结果存在相当大的挑战。在本次系统评价中，我们报告了评估临近生命终点的临床伦理支持服务的定性研究和调查的结果。
从 1970 年至 2018 年 5 月，通过电子数据库和其他来源进行了检索。两位作者独立筛选研究。评估了研究的方法学质量。对综述的每一部分，都进行了单独的综合分析。PROSPERO 注册号：CRD42016036241。
由于这是对已发表文献的系统评价，因此不需要伦理批准。
共在调查中发现了 2088 个记录，在定性研究中发现了 2786 个记录。经过筛选，纳入了 9 项调查和 4 项定性研究。调查研究报告了使用非常广泛和多样的结果的总体积极结果。偶尔也有负面结果的报道。然而，所使用结果的方法学质量和概念依据往往较弱，限制了结果的普遍性。
证据表明临床伦理支持服务有积极的结果。然而，方法学质量需要提高。进一步对评估临床伦理支持服务的定性或混合方法研究可能有助于通过拓宽（不同类型的）临床伦理支持服务的（面向过程的）适当结果范围来发展评估临床伦理支持服务结果的方法。
