Implementing clinical ethics committees as a complex intervention: presentation of a feasibility study in community care
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Implementing clinical ethics committees as a complex intervention: presentation of a feasibility study in community care Morten Magelssen1* , Heidi Karlsen1, Reidar Pedersen1 and Lisbeth Thoresen2
Abstract Background: How should clinical ethics support services such as clinical ethics committees (CECs) be implemented and evaluated? We argue that both the CEC itself and the implementation of the CEC should be considered as ‘complex interventions’. Main text: We present a research project involving the implementation of CECs in community care in four Norwegian municipalities. We show that when both the CEC and its implementation are considered as complex interventions, important consequences follow – both for implementation and the study thereof. Emphasizing four such sets of consequences, we argue, first, that the complexity of the intervention necessitates small-scale testing before larger-scale implementation and testing is attempted; second, that it is necessary to theorize the intervention in sufficient depth; third, that the identification of casual connections charted in so-called logic models allows the identification of factors that are vital for the intervention to succeed and which must therefore be studied; fourth, that an important part of a feasibility study must be to identify and chart as many as possible of the causally important contextual factors. Conclusion: The conceptualization of the implementation of a CEC as a complex intervention shapes the intervention and the way evaluation research should be performed, in several significant ways. We recommend that researchers consider whether a complex intervention approach is called for when studying CESS implementation and impact. Keywords: Clinical ethics, Clinical ethics committee, Clinical ethics support services, Complex intervention, Ethics in community care, Healthcare ethics
Background Clinical ethics support services (CESS) aid in the handling of ethical problems that arise in clinical practice [1, 2]. A common form of CESS is the clinical ethics committee (CEC). CECs have traditionally had three main tasks: Deliberation on clinical-ethical problems that either involve particular patients or more general ethical issues; education of clinical staff in topics pertaining to * Correspondence: [email protected] 1 Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Pb. 1130 Blindern, N-0318 Oslo, Norway Full list of author information is available at the end of the article
clinical ethics; and contributions to the development of institutional guidelines [3]. In these ways – and also through other activities [3] – CECs contribute to improved skills, knowledge and awareness of clinical ethics and better handling of ethically challenging situations that arise in practice [4]. However, establishing a successful CEC is no straightforward matter. Through working with the Norwegian CECs, our experience is that it takes several years to build up competence and experience among CEC members, to overcome bar
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