Domains of quality for clinical ethics case consultation: a mixed-method systematic review.
BACKGROUND
"Clinical ethics consultation" (CEC) is the provision of consultative services by an individual or team with the aim of helping health professionals, patients, and their families grapple with difficult ethical issues arising during health care. There are almost 25,000 articles in the worldwide literature on CEC, but very few explicitly address measuring the quality of CEC. Many more address quality implicitly, however. This article describes a rigorous protocol for compiling the diverse literature on CEC, analyzing it with a quality measurement lens, and seeking a set of potential quality domains for CEC based on areas of existing, but hitherto unrecognized, consensus in the literature.


METHODS
This mixed-method systematic review will follow a sequential pattern: scoping review, qualitative synthesis, and then a quantitative synthesis. The scoping review will include categorizing all quality measures for CEC discussed in the literature, both quantitative and qualitative. The qualitative synthesis will generate a comprehensive analytic framework for understanding the quality of CEC and is expected to inform the quantitative synthesis, which will be a meta-analysis of studies reporting the effects of CEC on pre-specified clinical outcomes.


CONCLUSIONS
The literature on CEC is broad and diverse and has never been examined with specific regard to quality measurement. We propose a novel mixed-methods approach to compile and synthesize this literature and to derive a framework for assessing quality in CEC.


BACKGROUND
PROSPERO CRD42015023282.
School of Medicine, University of Colorado, Anschutz Medical Campus, Denver, CO, USA. louis.fitch@ucdenver.edu.|University of Colorado-Center for Bioethics & Humanities, Fulginiti Pavilion for Bioethics and Humanities, Mailstop B137, 13080 E. 19th Avenue, Aurora, CO, 80045, USA. louis.fitch@ucdenver.edu.
Louis
L
Leslie
University of Colorado at Denver, Downtown Campus, Denver, CO, USA.
Rebecca Frances
RF
Cherry
School of Medicine, University of Colorado, Anschutz Medical Campus, Denver, CO, USA.
Abbas
A
Mulla
Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Denver, CO, USA.
Jean
J
Abbott
School of Medicine, University of Colorado, Anschutz Medical Campus, Denver, CO, USA.
Kristin
K
Furfari
Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Denver, CO, USA.
Jacqueline J
JJ
Glover
Health Sciences Library, University of Colorado, Anschutz Medical Campus, Denver, CO, USA.
Benjamin
B
Harnke
School of Medicine, University of Colorado, Anschutz Medical Campus, Denver, CO, USA.|Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Denver, CO, USA.
Matthew K
MK
Wynia
D026690:Ethics, Clinical; D006801:Humans; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation / Q000592:standards*
Bioethics; Clinical ethics; Ethics consultation; Health care ethics committees; Mixed-method; Scoping review; Systematic review