Table 3.
Characteristics of the included studies
| Reference number | Authors | Journal | Title | Country | Setting and participants of the conversation | Data collection and respondents | Conversation method | Type of case |
|---|---|---|---|---|---|---|---|---|
| 28 | Appelbaum & Reiser (1981) | Hospital & Community Psychiatry | Ethics rounds: a model for teaching ethics in the psychiatric setting | USA | Mental healthcare, multidisciplinary | Quantitative: questionnaires among participants | Presentation and discussion, no particular method mentioned | Patient cases, retrospective (occasionally active) |
| 30 | Baumann-Hölzle, Maffezzoni & Bucher (2005) | Acta Pædiatrica | A framework for ethical decision making in neonatal intensive care | Switzerland | Hospital care (neonatal IC), multidisciplinary | Quantitative: questionnaires among participants; survival comparison with controls | Locally developed framework for structured decision making | Patient cases, prospective |
| 16 | Bernthal, Russell & Draper (2014) | Journal of the Royal Army Medical Corps | A qualitative study of the use of the four quadrant approach to assist ethical decision-making during deployment | United Kingdom | Military hospital care, health professionals | Qualitative: analysis of case conference forms; interviews with participants | Four Quadrant Approach (4QA) | Patient cases |
| 33 | Dauwerse, Weidema, Abma, Molewijk & Widdershoven (2014) | HEC Forum | Implicit and explicit clinical ethics support in The Netherlands: a mixed methods overview study | The Netherlands, Norway | Various settings, multidisciplinary | Quantitative: surveys. Qualitative: interviews and focus groups with management and ethics support staff | No particular method mentioned | Not specified |
| 27 | De Boer, Van Blijderveen, Van Dijk, Duivenvoorden & Williams (2012) | Journal of Medical Ethics | Implementing structured, multiprofessional medical ethical decision-making in a neonatal intensive care unit | The Netherlands | Hospital care (neonatal IC), multidisciplinary | Quantitative: questionnaires with staff | Five-step procedure based on Utrecht model and Nijmegen method | Patient cases, prospective (fictional cases when no actual case was at hand) |
| 12 | Grönlund, Dahlqvist, Zingmark, Sandlund & Söderberg (2016) | HEC Forum | Managing Ethical Difficulties in Healthcare: Communicating in Inter-professional Clinical Ethics Support Sessions | Sweden | “Highly specialized healthcare clinic”, multidisciplinary | Qualitative: content-analysis of audio and video recorded ethics sessions | Several steps, no particular method mentioned | Patient cases |
| 7 | Janssens, Zadelhoff, Van Loo, Widdershoven & Molewijk (2016) | Nursing Ethics | Evaluation and perceived results of moral case deliberation: A mixed methods study | The Netherlands, Norway | Elderly care, multidisciplinary | Quantitative and qualitative: questionnaires with participants; interviews; focus groups | Dilemma method or Socratic dialogue | Patient cases |
| 13 | Jehle & Jurchah (2014) | Topics in Stroke Rehabilitation | Patient With a Devastating Embolic Stroke: Using Weekly Multidisciplinary Ethics Rounds in the Neuroscience Intensive Care Unit to Facilitate Care and Communication | USA | Hospital care (neuroscience IC), multidisciplinary | Quantitative: surveys, not specified | “FESOR” format: Facts, Ethical question, Stakeholders, Options, Re-evaluation | Patient cases |
| 31 | Levine, Scott & Curran (1977) | Pediatrics | Ethics rounds in a Children’s Medical Center: evaluation of a hospital-based program for continuing education in medical ethics | USA | Children’s hospital care, multidisciplinary | Quantitative and qualitative: content-analysis of discussions; interviews and surveys among participants | Presentation and discussion, no particular method mentioned | Patient cases, retrospective |
| 32 | Lillemoen & Pedersen (2015) | BMC Medical Ethics | Ethics reflection groups in community health services: an evaluation study | Norway | Community health services, not clearly specified | Qualitative: focus groups with 1) participants, 2) ethics facilitators and 3) service managers; content analysis of documentation and observations | Centre for Medical Ethics method | Patient cases; constructed cases |
| 36 | Maffezzoni, Wunder, Baumann-Hölzle & Stoll (2003) | Zeitschrift für Arbeits- und Organisations-psychologie | Gruppenprozesse bei Entscheidungen zur Levensfähigkeit von Neugeborenen – Eine formative Evaluation | Switzerland | Hospital care (neonatal IC), multidisciplinary | Quantitative and qualitative: questionnaires among participants; analysis of video recorded sessions and conversation protocols | Locally developed ethical decision-making model | Patient cases, prospective |
| 34 | Meyer-Zehnder, Barandun Schäfer, Albisser Schleger, Reiter-Theil & Pargger (2014) | Der Anaesthesist | Ethische Fallbesprechungen auf der Intensivstation Vom Versuch zur Routine |
Switzerland | Hospital care (IC), multidisciplinary | Quantitative: questionnaires among participants; summary of conversation protocols | “METAP” format: Module, Ethik, Therapieentscheidung, Allokation, Prozess | Patient cases, prospective |
| 4 | Molewijk, Verkerk, Milius & Widdershoven (2008) | Medicine, Health Care and Philosophy | Implementing moral case deliberation in a psychiatric hospital: process and outcome | The Netherlands | Mental healthcare, multidisciplinary | Quantitative and qualitative responsive evaluation: a questionnaire among participants; interviews with various stakeholders; participant observation; document analysis | Structured conversation, no particular method mentioned | Patient cases, retrospective and prospective |
| 5 | Molewijk, Abma, Stolper & Widdershoven (2008) | Journal of Medical Ethics | Teaching ethics in the clinic. The theory and practice of moral case deliberation | The Netherlands | Mental healthcare | Responsive evaluation approach | Depending on the case | Patient cases, professional-centered issues, and organization-centered questions |
| 18 | Silén, Haglund, Hansson & Ramklint (2015) | Nordic Journal of Psychiatry | Ethics rounds do not improve the handling of ethical issues by psychiatric staff | Sweden | Mental healthcare, multidisciplinary | Quasi-experimental: questionnaires in both intervention and control groups | Approach of imaginative ethics, no particular method mentioned | Patient case or theme |
| 14 | Silén, Ramklint, Hansson & Haglund (2016) | Nursing Ethics | Ethics rounds: An appreciated form of ethics support | Sweden | Mental healthcare, multidisciplinary | Qualitative exploratory and descriptive design: interviews with participants | Approach of imaginative ethics, no particular method mentioned | Patient case or theme |
| 17 | Söderhamn, Kjøstvedt & Slettebø (2014) | Nursing Ethics | Evaluation of ethical reflections in community healthcare: A mixed-methods study | Norway | Community health services | Qualitative and quantitative: focus groups with participants; questionnaires with employees | Traffic light method and fishbowl method | Ethical dilemmas |
| 35 | Svantesson, Anderzén-Carlsson, Thorsén, Kallenberg & Ahlström (2008) | Journal of Medical Ethics | Interprofessional ethics rounds concerning dialysis patients: staff’s ethical reflections before and after rounds | Sweden | Hospital care (nephrology), multidisciplinary | Quantitative and qualitative: questionnaires; content analysis of open-ended questions | Ethics rounds, no particular method mentioned | Patient cases |
| 29 | Svantesson, Löfmark, Thorsén, Kallenberg & Ahlström (2008) | Journal of Medical Ethics | Learning a way through ethical problems: Swedish nurses’ and doctors’ experiences from one model of ethics rounds | Sweden | Hospital care (nephrology), multidisciplinary | Qualitative: interviews with participants | Ethics rounds, no particular method mentioned | Patient cases |
| 15 | Tanner, Albisser Schleger, Meyer-Zehnder, Schnurrer, Reiter-Theil & Pargger (2014) | Medizinische Klinik – Intensiv-medizin und Notfall-medizin | Klinische Alltagsethik – Unterstützung im Umgang mit moralischem Disstress? Evaluation eines ethischen Entscheidungsfindungsmodellsfür interprofessionelle klinische Teams |
Switzerland | Hospital care (IC and geriatrics), multidisciplinary | Qualitative and quantitative: individual and group interviews with employees; questionnaires among employees | “METAP” format: Module, Ethik, Therapieentscheidung, Allokation, Prozess | Patient cases |
| 8 | Van der Dam, Abma, Molewijk, Kardol, Schols & Widdershoven (2011) | Nursing Ethics | Organizing moral case deliberation Experiences in two Dutch nursing homes | The Netherlands | Elderly care, multidisciplinary | Qualitative: interviews with managers; observations and (tape) recordings of sessions; focus groups with participants | Depending on the case | Patient cases |
| 9 | Van der Dam, Schols, Kardol, Molewijk, Widdershoven & Abma (2013) | Social Science & Medicine | The discovery of deliberation. From ambiguity to appreciation through the learning process of doing Moral Case Deliberation in Dutch elderly care | The Netherlands | Elderly care, multidisciplinary | Qualitative: interviews with managers and other stakeholders; observations and (tape) recordings of sessions; focus groups with participants | Depending on the case | Patient cases |
| 26 | Voskes, Evenblij, Noorthoorn, Porz & Widdershoven (2014) | Psychiatrische Praxis | Ethische Fall-Deliberation zu Freiheitseinschränkungen in der Psychiatrie. Dilemmata, Nutzen und Implementierung | The Netherlands, Switzerland | Mental healthcare, multidisciplinary | Qualitative: interviews and focus groups with participants/employees; observation of sessions | Dilemma method | Patient cases, retrospective and prospective |
| 6 | Weidema, Molewijk, Kamsteeg & Widdershoven (2013) | Nursing Ethics | Aims and harvest of moral case deliberation | The Netherlands | Mental healthcare, mono-disciplinary (nurses) | Qualitative and quantitative: interviews with managers; questionnaires with participants | Structured conversation, no particular method mentioned | Concrete work-based case |
| 11 | Wocial, Hancock, Bledsoe, Chamness & Helft (2010) | JONA’S Healthcare Law, Ethics, and Regulation | An evaluation of unit-based ethics conversations | USA | Hospital care (different nursing units), mono-disciplinary (nurses) | Quantitative and qualitative: a survey among employees; focus group with participants | Structured story-telling, no particular method mentioned | Ethically challenging situations in care |