title: An ethical framework for cardiac report cards: a qualitative study.
abstract: BACKGROUND
  The recent proliferation of health care report cards, especially in cardiac care, has occurred in the absence of an ethical framework to guide in their development and implementation. An ethical framework is a consistent and comprehensive theoretical foundation in ethics, and is formed by integrating ethical theories, relevant literature, and other critical information (such as the views of stakeholders). An ethical framework in the context of cardiac care provides guidance for developing cardiac report cards (CRCs) that are relevant and legitimate to all stakeholders. The purpose of this study is to develop an ethical framework for CRCs.
  
  
  METHODS
  Delphi technique - 13 panelists: 2 administrators, 2 cardiac nurses, 5 cardiac patients, 2 cardiologists, 1 member of the media, and 1 outcomes researcher. Panelists' views regarding the ethics of CRCs were analyzed and organized into themes.
  
  
  RESULTS
  We have organized panelists' views into ten principles that emerged from the data: 1) improving quality of care, 2) informed understanding, 3) public accountability, 4) transparency, 5) equity, 6) access to information 7) quality of information, 8) multi-stakeholder collaboration, 9) legitimacy, and 10) evaluation and continuous quality improvement.
  
  
  CONCLUSIONS
  We have developed a framework to guide the development and dissemination of CRCs. This ethical framework can provide necessary guidance for those generating CRCs and may help them avoid a number of difficult issues associated with existing ones.
authors.affiliation: University of Toronto Joint Centre for Bioethics, 88 College Street, Toronto, Ontario, M5G, Canada 1L4. douglas.martin@utoronto.ca.
authors.forename: Shawn A
authors.initials: SA
authors.lastname: Richard
authors.forename: Shail
authors.initials: S
authors.lastname: Rawal
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Martin
mesh_terms: D022126:Access to Information; D000288:Administrative Personnel; D002309:Cardiology / Q000592:standards*; D003697:Delphi Technique; D006282:Health Personnel; D006801:Humans; D033181:Information Dissemination / Q000941:ethics* / Q000379:methods*; D007258:Informed Consent; D010043:Outcome and Process Assessment, Health Care / Q000941:ethics*; D010358:Patient Participation; D011050:Policy Making; D036301:Qualitative Research; D011787:Quality of Health Care / Q000941:ethics* / Q000458:organization & administration*; D012935:Social Justice; D012941:Social Responsibility