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A Participatory, Mixed-Methods Assessment of Clinical Ethics Committees: How Might They Support Clinicians and Positively Impact Care?

Raffel, Kathleen Keefe
http://rave.ohiolink.edu/etdc/view?acc_num=osu1369866382

Abstract Details

2013, Doctor of Philosophy, Ohio State University, Social Work.
The primary purpose of this exploratory study to learn how clinical ethics committees in one healthcare system might be more effective in supporting clinicians and their work in critical care settings. This study also attempted to address several issues in previous research. First, committees frequently lack information on what they could do to meet the needs of clinicians facing moral dilemmas, making it challenging for committees to be proactive, purposefully choose committee members and determine their training needs, and plan and support relevant services. Second, most needs assessments have solicited a top-down, management perspective rather than the views of constituent stakeholders. Third, ethics committees activities are often inadequately operationalized and difficult to evaluate. Finally, few studies have examined how different committee activities might potentially impact care. This research was done in partnership with a large healthcare organization in central Ohio. The community partner wanted data that would drive strategic planning, program development, and evaluation for the seven ethics committees in its system. This study used a structured, mixed methodology, concept mapping, which is specifically designed to analyze and integrate the perspectives of multiple stakeholders. Data was collected from both ethics committee members and a diverse, multi-disciplinary sample of critical care clinicians to generate an inventory of 95 potential committee functions which might support the critical care units. Participants rated each suggestion on two dimensions: potential to positively impact care and perceived current performance by the ethics committees. Rigorous statistical analyses were used to integrate and analyze the data collected. The “concept maps” produced after data analysis graphically displayed multiple dimensions of ethics committee work and performance. Non committee members organized the suggested committee activities into seven different categories: staff development, guidance, outreach and accessibility, visibility, liaison with system, liaison with patients and families, and ethical and moral support. Individual ideas within each group help operationalize these broader functions and point to potential committee activities beyond the three traditional roles of education, policy development and consultation. Broadly speaking, the participants unaffiliated with ethics committees thought the suggested activities could have more positive impact on patient care than committee members did. Conversely, committee members rated their performance higher than non committee members did. Views about potential impact and perceived current performance varied among the hospitals participating in the rating activity. Within the same hospital, ratings varied among critical care units. A number of other variables - profession, years in healthcare, involvement with ethics committee consults, and use of the ethics committee as the first resource when questions about an ethical dilemma arise – also seemed to influence how ideas were rated. The findings suggest that ethics committees could have a positive impact on care by being more visible and accessible and working directly and proactively with families, particularly around end-of-life dilemmas. Participants also identified a need for interventions which provide staff with moral and ethical support. Social work opportunities for working with ethics committees to address moral and ethical issues, supporting staff emotional needs, and improving communication with families are presented.
Mo Yee Lee, PhD (Advisor)
Tamara Davis, PhD (Committee Member)
Keith Anderson, PhD (Committee Member)
Pedro Weisleder, MD PhD (Committee Member)
363 p.
Alternative Dispute Resolution; Health Care Management; Medical Ethics; Social Work
medical ethics; ethics committees; mixed-methods; participatory research; concept mapping; social work; alternative dispute resolution

Recommended Citations

Citations

  • Raffel, K. K. (2013). A Participatory, Mixed-Methods Assessment of Clinical Ethics Committees: How Might They Support Clinicians and Positively Impact Care? [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1369866382

    APA Style (7th edition)

  • Raffel, Kathleen. A Participatory, Mixed-Methods Assessment of Clinical Ethics Committees: How Might They Support Clinicians and Positively Impact Care? . 2013. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1369866382.

    MLA Style (8th edition)

  • Raffel, Kathleen. "A Participatory, Mixed-Methods Assessment of Clinical Ethics Committees: How Might They Support Clinicians and Positively Impact Care? ." Doctoral dissertation, Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1369866382

    Chicago Manual of Style (17th edition)

osu1369866382
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This open access ETD is published by The Ohio State University and OhioLINK.