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Objectives and outcomes of clinical ethics services: a Delphi study
  1. Leah McClimans1,
  2. Geah Pressgrove2,
  3. Emmaling Campbell1
  1. 1 Philosophy, University of South Carolina, Columbia, South Carolina, USA
  2. 2 Reed College of Media, West Virginia University, Morgantown, West Virginia, USA
  1. Correspondence to Dr Leah McClimans, Philosophy, University of South Carolina, Columbia, SC 29208, USA; lmm{at}


Objectives To explore the objectives and outcomes most appropriate for evaluating clinical ethics support services (CESs) in the USA.

Methods A three-round e-Delphi was sent to two professional medical ethics listservs (Medical College of Wisconsin-Bioethics and American Society for Bioethics and Humanities) as well as 19 individual experts. The survey originally contained 15 objectives and 9 outcomes. In round 1, participants were asked to validate the content of these lists. In round 2, we had 17 objectives and 10 outcomes, and participants were asked to rank them for appropriateness in a top 10 list of objectives and a top 5 list of outcomes.

Results Participants came to a high(at least 70%) level of agreement on seven objectives: mediate, educate, develop policy, improve the moral quality of a decision or action, counsel, create a moral space and manage moral distress. Participants came to a moderate (at least 51%) level of agreement on three objectives: empower, awareness of ethics and preventative ethics. Participants also came to a moderate (at least 51%) level of agreement on five outcomes: ethical justification, transformation of institution, improvement of quality of life, principled consensus and satisfaction with the expertise of a CES.

Conclusion This e-Delphi identified 10 objectives and 5 outcomes that are a good starting point for developing outcome measures to evaluate CESs in the USA, while reminding us of the diversity of perspectives still evident in the field.

  • clinical ethics
  • ethics committees/consultation
  • quality of health care

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  • Contributors LM co-designed the study with GP, conducted the study with EC, analysed the data with both GP and EC, and wrote the manuscript with editorial suggestions from GP. EC completed the original table and figures and LM completed all revisions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.