From ethical challenges to ethics support: a mixed-methods study on implementing a clinical ethics committee in clinical practice (EVACEC)

Background Clinical Ethics Committees (CECs) are services for supporting healthcare professionals (HPs) in dealing with ethical issues in clinical practice. The CEC of the Local Health Authority (LHA) of Reggio Emilia was implemented in 2020 in the context of a research project (EVACEC) aimed at identifying how a CEC can be successfully normalized within a healthcare organization. This mixed-methods article describes the CEC’s dissemination, use and integration among HPs, with a focus on the experiences of those who required ethics consultation. Methods Quantitative data on dissemination, knowledge, and use of CEC were gathered through an online survey sent to all HPs of the LHA and were analyzed by descriptive statistics. Qualitative data were collected by semi-structured interviews with those HPs who submitted an ethics consultation request and were analyzed by thematic analysis. Results Two hundred seventy-three HPs completed the survey, with 80.6% reporting to have faced at least one ethical issue in their clinical practice. 57.7% were aware of the service, with heterogeneous levels of knowledge about the CEC functions, composition, and target users; barriers to access were also identified. Among them, only 23.4% had actually utilized it and 85.7% of this subsample found it useful. From June 2022 to October 2022, 5 HPs who submitted a request to the CEC were interviewed. Thematic analysis revealed four themes: (i) a sense of loneliness in the decision-making process: seeking ethical support; (ii) valued features of the CEC: a source of mutual and expert support; (iii) how ethics consultation supports medical decision-making; (iv) trust, visibility, and access: key features to normalization. Conclusions Our findings show that when accessed, CEC offered support by providing multidisciplinary perspectives and fostering deliberation in morally complex situations. However, the limited awareness and use of the CEC among those HPs most exposed to ethical issues suggests that further institutional efforts (i.e. integrating ethics training into routine clinical practice and establishing clearer referral pathways), are required to improve its dissemination and ethical sensitivity among HPs. Further research is needed to assess the long-term impact of these implementation strategies to identify best practices for CEC normalization. Trial registration The protocol has been registered on ClinicalTrail.gov (registration n. NCT05466292).