title: MORECare research methods guidance development: recommendations for ethical issues in palliative and end-of-life care research.
abstract: BACKGROUND
  There is little guidance on the particular ethical concerns that research raises with a palliative care population.
  
  
  OBJECTIVE
  To present the process and outcomes of a workshop and consensus exercise on agreed best practice to accommodate ethical issues in research on palliative care.
  
  
  METHODS
  Consultation workshop using the MORECare Transparent Expert Consultation approach. Prior to workshops, participants were sent overviews of ethical issues in palliative care. Following the workshop, nominal group techniques were used to produce candidate recommendations. These were rated online by participating experts. Descriptive statistics were used to analyse agreement and consensus. Narrative comments were collated.
  
  
  METHODS
  Experts in ethical issues and palliative care research were invited to the Cicely Saunders Institute in London. They included senior researchers, service providers, commissioners, researchers, members of ethics committees and policy makers.
  
  
  RESULTS
  The workshop comprised 28 participants. A total of 16 recommendations were developed. There was high agreement on the issue of research participation and high to moderate agreement on applications to research ethics committees. The recommendations on obtaining and maintaining consent from patients and families were the most contentious. Nine recommendations were refined on the basis of the comments from the online consultation.
  
  
  CONCLUSIONS
  The culture surrounding palliative care research needs to change by fostering collaborative approaches between all those involved in the research process. Changes to the legal framework governing the research process are required to enhance the ethical conduct of research in palliative care. The recommendations are relevant to all areas of research involving vulnerable adults.
authors.affiliation: Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK and Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Gysels
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Evans
authors.forename: Penney
authors.initials: P
authors.lastname: Lewis
authors.forename: Peter
authors.initials: P
authors.lastname: Speck
authors.forename: Hamid
authors.initials: H
authors.lastname: Benalia
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Preston
authors.forename: Gunn E
authors.initials: GE
authors.lastname: Grande
authors.forename: Vicky
authors.initials: V
authors.lastname: Short
authors.forename: Eleanor
authors.initials: E
authors.lastname: Owen-Jones
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Todd
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
mesh_terms: D026688:Bioethical Issues; D004992:Ethics, Medical; D006302:Health Services Research / Q000941:ethics*; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D010166:Palliative Care / Q000941:ethics* / Q000379:methods; D018579:Patient Selection / Q000941:ethics; D013727:Terminal Care / Q000941:ethics* / Q000379:methods
keywords: Ethics; consensus methods; end-of-life care; expert workshop; guidance development; online consultation; palliative care; research