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Role of a Clinical Ethics Committee in Residential Aged Long-Term Care Settings: A Systematic Review.
J Am Med Dir Assoc. 2020 Jul 28 [Online ahead of print]JA

Abstract

OBJECTIVES

To conduct a systematic review of literature examining the establishment and operation of clinical ethical committees (CECs) in long-term care (LTC).

DESIGN

Systematic review.

SETTING AND PARTICIPANTS

LTC recipients/family or staff.

METHODS

Five databases (Ovid Medline, Ovid Cochrane Library, Ovid PsycINFO, Ovid EMBASE, and CINAHL via EbscoHost) were systematically searched from their inception to May 8, 2020. The initial search was conducted on August 22, 2017, and updated on May 8, 2020, to identify peer-reviewed studies, commentaries, or editorials. The quality of studies was assessed using the Mixed Methods Appraisal Tool.

RESULTS

Thirty-three articles were identified for inclusion, of which 13 were primary studies. Most articles were set in the United States. The purpose of establishing a CEC in LTC was typically to assist in dealing with ethical issues and improve the quality of care. The articles described the roles of CECs to include prospective case consultation, case review, policy development, and ethics education. Articles rarely reported whether the CEC was required by or enshrined in law. Membership of CECs was between 4 and 20 members and most commonly included nursing staff, physicians, and directors/administrators. The rationale behind the membership was rarely described. For case consultation, articles described that CECs were typically convened upon referral. The resident issues which a CEC could address included end-of-life care decisions, autonomy/self-determination, and medical treatment decisions. The staff issues addressed by CECs included medical treatment decisions, end-of-life care decisions, and decision-making issues. The decision-making process followed by CECs varied. The outcome of a CEC meeting was typically a recommendation, whereas the implementation of CEC recommendations and decisions were rarely reported.

CONCLUSIONS AND IMPLICATIONS

This systematic review identifies how CECs operate in the LTC setting. CECs have the potential to provide valuable support in addressing complex ethical issues in LTC; however, empirical research is required to determine their efficacy in the LTC setting.

Authors+Show Affiliations

Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia.Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia; Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.Health Law and Aging Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia. Electronic address: joseph.ibrahim@monash.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32736991

Citation

Holmes, Alice L., et al. "Role of a Clinical Ethics Committee in Residential Aged Long-Term Care Settings: a Systematic Review." Journal of the American Medical Directors Association, 2020.
Holmes AL, Bugeja L, Ibrahim JE. Role of a Clinical Ethics Committee in Residential Aged Long-Term Care Settings: A Systematic Review. J Am Med Dir Assoc. 2020.
Holmes, A. L., Bugeja, L., & Ibrahim, J. E. (2020). Role of a Clinical Ethics Committee in Residential Aged Long-Term Care Settings: A Systematic Review. Journal of the American Medical Directors Association. https://doi.org/10.1016/j.jamda.2020.05.053
Holmes AL, Bugeja L, Ibrahim JE. Role of a Clinical Ethics Committee in Residential Aged Long-Term Care Settings: a Systematic Review. J Am Med Dir Assoc. 2020 Jul 28; PubMed PMID: 32736991.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of a Clinical Ethics Committee in Residential Aged Long-Term Care Settings: A Systematic Review. AU - Holmes,Alice L, AU - Bugeja,Lyndal, AU - Ibrahim,Joseph E, Y1 - 2020/07/28/ PY - 2020/01/29/received PY - 2020/05/20/revised PY - 2020/05/21/accepted PY - 2020/8/2/entrez KW - Clinical ethics committee KW - ethical conflict KW - long-term care KW - systematic review JF - Journal of the American Medical Directors Association JO - J Am Med Dir Assoc N2 - OBJECTIVES: To conduct a systematic review of literature examining the establishment and operation of clinical ethical committees (CECs) in long-term care (LTC). DESIGN: Systematic review. SETTING AND PARTICIPANTS: LTC recipients/family or staff. METHODS: Five databases (Ovid Medline, Ovid Cochrane Library, Ovid PsycINFO, Ovid EMBASE, and CINAHL via EbscoHost) were systematically searched from their inception to May 8, 2020. The initial search was conducted on August 22, 2017, and updated on May 8, 2020, to identify peer-reviewed studies, commentaries, or editorials. The quality of studies was assessed using the Mixed Methods Appraisal Tool. RESULTS: Thirty-three articles were identified for inclusion, of which 13 were primary studies. Most articles were set in the United States. The purpose of establishing a CEC in LTC was typically to assist in dealing with ethical issues and improve the quality of care. The articles described the roles of CECs to include prospective case consultation, case review, policy development, and ethics education. Articles rarely reported whether the CEC was required by or enshrined in law. Membership of CECs was between 4 and 20 members and most commonly included nursing staff, physicians, and directors/administrators. The rationale behind the membership was rarely described. For case consultation, articles described that CECs were typically convened upon referral. The resident issues which a CEC could address included end-of-life care decisions, autonomy/self-determination, and medical treatment decisions. The staff issues addressed by CECs included medical treatment decisions, end-of-life care decisions, and decision-making issues. The decision-making process followed by CECs varied. The outcome of a CEC meeting was typically a recommendation, whereas the implementation of CEC recommendations and decisions were rarely reported. CONCLUSIONS AND IMPLICATIONS: This systematic review identifies how CECs operate in the LTC setting. CECs have the potential to provide valuable support in addressing complex ethical issues in LTC; however, empirical research is required to determine their efficacy in the LTC setting. SN - 1538-9375 UR - https://www.unboundmedicine.com/medline/citation/32736991/Role_of_a_Clinical_Ethics_Committee_in_Residential_Aged_Long_Term_Care_Settings:_A_Systematic_Review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-8610(20)30478-3 DB - PRIME DP - Unbound Medicine ER -
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