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Palliative care
Protocol
Real-world ethics in palliative care: protocol for a systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice
  1. Guy Schofield1,
  2. Emer Brangan2,
  3. Mariana Dittborn3,
  4. Richard Huxtable1,
  5. Lucy Selman4
  1. 1 Centre for Ethics in Medicine, University of Bristol, Bristol, UK
  2. 2 The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  3. 3 Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
  4. 4 School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Dr Guy Schofield; guy.schofield{at}bristol.ac.uk

Abstract

Introduction Ethical issues arise daily in the delivery of palliative care. Despite much (largely theoretical) literature, evidence from specialist palliative care practitioners (SPCPs) about real-world ethical challenges has not previously been synthesised. This evidence is crucial to inform education and training and adequately support staff. The aim of this systematic review is to synthesise the evidence regarding the ethical challenges which SPCPs encounter during clinical practice.

Methods and analysis We will conduct a systematic review with narrative synthesis of empirical studies that use inductive methods to describe the ethical challenges reported by SPCPs. We will search multiple databases (MEDLINE, Philosopher’s Index, EMBASE, PsycINFO, LILACS, WHOLIS, Web of Science and CINAHL) without time, language or geographical restrictions. Keywords will be developed from scoping searches, consultation with information specialists and reference to key systematic reviews in palliative care and bioethics. Reference lists of included studies will be hand-searched. 10% of retrieved titles and abstracts will be independently dual screened, as will all full text papers. Quality will be dual assessed using the Mixed-Methods Appraisal Tool (2018). Narrative synthesis following Popay et al (2006) will be used to synthesise findings. The strength of resulting recommendations will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach for qualitative evidence (GRADE-CERQual).

Ethics and dissemination As this review will include only published data, no specific ethical approval is required. We anticipate that the systematic review will be of interest to palliative care practitioners of all backgrounds and educators in palliative care and medical ethics. Findings will be presented at conferences and published open access in a peer-reviewed journal.

Trial registration number CRD42018105365.

  • palliative care
  • empirical ethics
  • medical ethics
  • systematic review
  • ethical challenges

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2018-028480

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    Footnotes

    • Contributors GS, LS, EB and RH conceived of the review and developed the protocol. GS, EB, MD and RH developed the search strategy. GS and LS wrote the manuscript draft. All authors revised and edited the draft manuscript and approved the final version.

    • Funding This work was supported by Wellcome Trust Research Award for Health Professionals (208129/Z/17/Z) for GS. The sponsor is the University of Bristol.

    • Competing interests None declared.

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

    • Patient consent for publication Not required.