Evaluating the effectiveness of clinical ethics committees: a systematic review
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REVIEW ARTICLE
Evaluating the effectiveness of clinical ethics committees: a systematic review Chiara Crico1,2,4 · Virginia Sanchini1,2,3 · Paolo Giovanni Casali1,4 · Gabriella Pravettoni1,2 Accepted: 21 October 2020 © The Author(s) 2020
Abstract Clinical Ethics Committees (CECs), as distinct from Research Ethics Committees, were originally established with the aim of supporting healthcare professionals in managing controversial clinical ethical issues. However, it is still unclear whether they manage to accomplish this task and what is their impact on clinical practice. This systematic review aims to collect available assessments of CECs’ performance as reported in literature, in order to evaluate CECs’ effectiveness. We retrieved all literature published up to November 2019 in six databases (PubMed, Ovid MEDLINE, Scopus, Philosopher’s Index, Embase and Web of Science), following PRISMA guidelines. We included only articles specifically addressing CECs and providing any form of CECs performance assessment. Twenty-nine articles were included. Ethics consultation was the most evaluated of CECs’ functions. We did not find standardized tools for measuring CECs’ efficacy, but 33% of studies considered “user satisfaction” as an indicator, with 94% of them reporting an average positive perception of CECs’ impact. Changes in patient treatment and a decrease of moral distress in health personnel were reported as additional outcomes of ethics consultation. The highly diverse ways by which CECs carry out their activities make CECs’ evaluation difficult. The adoption of shared criteria would be desirable to provide a reliable answer to the question about their effectiveness. Nonetheless, in general both users and providers consider CECs as helpful, relevant to their work, able to improve the quality of care. Their main function is ethics consultation, while less attention seems to be devoted to bioethics education and policy formation. Keywords Clinical ethics committees · Ethics committees · Systematic review · Effectiveness · Evaluation · Satisfaction · Helpfulness
Background Clinical Ethics Committees (CECs) or Hospital Ethics Committees are bodies originally established with the aim of supporting healthcare professionals in managing controversial ethical issues affecting clinical practice (Fleetwood et al. 1989) that cannot be settled simply in terms of medical * Virginia Sanchini [email protected] 1
Department of Oncology and Hemato‑Oncology, University of Milan, Milan, Italy
2
Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
3
Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
4
Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
competence (Renzi et al. 2016). The same aim is pursued by all those services commonly labelled as Clinical Ethics Support Services (CESS), i.e. services aiming at supporting health-care professionals and/or patients a
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