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Evaluating interventions to improve ethical decision making in clinical practice: a review of the literature and reflections on the challenges posed
  1. Agnieszka Ignatowicz1,
  2. Anne Marie Slowther2,
  3. Christopher Bassford3,4,
  4. Frances Griffiths4,
  5. Samantha Johnson5,
  6. Karen Rees4
  1. 1 Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  2. 2 Warwick Medical School, University of Warwick, Coventry, UK
  3. 3 University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  4. 4 University of Warwick, Warwick Medical School, Coventry, UK
  5. 5 Library Services, University of Warwick, Coventry, UK
  1. Correspondence to Prof Anne Marie Slowther, Warwick Medical School, University of Warwick, Coventry, UK; a-m.slowther{at}


Since the 1980s, there has been an increasing acknowledgement of the importance of recognising the ethical dimension of clinical decision-making. Medical professional regulatory authorities in some countries now include ethical knowledge and practice in their required competencies for undergraduate and post graduate medical training. Educational interventions and clinical ethics support services have been developed to support and improve ethical decision making in clinical practice, but research evaluating the effectiveness of these interventions has been limited. We undertook a systematic review of the published literature on measures or models of evaluation used to assess the impact of interventions to improve ethical decision making in clinical care. We identified a range of measures to evaluate educational interventions, and one tool used to evaluate a clinical ethics support intervention. Most measures did not evaluate the key impact of interest, that is the quality of ethical decision making in real-world clinical practice. We describe the results of our review and reflect on the challenges of assessing ethical decision making in clinical practice that face both developers of educational and support interventions and the regulatory organisations that set and assess competency standards.

  • decision making
  • ethics- medical
  • health personnel
  • education

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  • Contributors AMS and CB led the study from design through to writing up study reports. FG led the qualitative component of the study. KR led the literature synthesis component of the study. AI, AMS and KR undertook this systematic review. SJ structured the database searches for the systematic review. AI and AMS drafted this paper. All authors contributed to writing the paper and read and approved the final version. AMS is the acting guarantor.

  • Funding This study was funded by National Institute for Health Research (NIHR) (13/10/14).

  • Disclaimer This review presents independent research commissioned by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, MRC, CCF, NETSCC, the HS&DR programme or the Department of Health.

  • Competing interests AMS, FG, KR and AI received grants from the UK National Institute of Health Research during the conduct of the study pertaining to this manuscript.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.