Relevance of clinical ethics support services in specialized outpatient palliative care teams and inpatient hospices

BACKGROUND AND OBJECTIVES: Clinical ethics support services (CES) may support palliative care teams in ethical conflicts. However, it is not known to what extent these services are available, used and how their relevance is perceived by the teams. The study focuses on the accessibility and evaluation of ethics consultations in specialized outpatient palliative care teams and inpatient hospices. METHODS: This study conducted a cross-sectional 21-item anonymous survey among teams of registered specialized outpatient palliative care services (n = 304) and inpatient hospices (n = 260) in Germany concerning availability, utilization and evaluation of clinical ethics support services. RESULTS: A total of 175 (58%) specialized outpatient palliative care teams and 102 (39%) inpatient hospice teams responded to the questionnaire; of these two-thirds have access to CES. A number of ethical challenges were reported in these settings, many of which are perceived as burdensome. However, satisfaction with existing services is rather moderate and teams report fewer than five consultations per year. Nevertheless, ethics consultation is regarded as being highly useful, with positive effects reported, including enhanced confidence in decision-making processes and reduced burden for team members. Interestingly, team members with formal training in clinical ethics had a significant positive impact on the perception of CES and the frequency of consultations. CONCLUSION: Although specialized outpatient palliative care and inpatient hospice teams reported facing a number of burdensome ethical challenges, ethics consultations fall short of accessibility to CES. This discrepancy can be resolved by structured training of team members in clinical ethics to increase the level of awareness and utilization of CES in specialized outpatient palliative care and inpatient hospices.