Macro-Level Factors Influencing the Adoption and Early Implementation of Clinical Ethics Support Services: A Scoping Review.

Abstract

Clinical ethics are becoming increasingly important in the twenty-first century. Value-laden cases and moral dilemmas in healthcare have led to the creation of clinical ethics support structures. The last decades have shown their implementation in hospitals around the globe. Recent literature investigates their value, function, and integration. Many conclude that they do valuable work yet remain inadequately integrated, lack institutionalization, and struggle with resource shortages. To gain an understanding of this development and pave the way for future implementation and research, a scoping review was chosen to determine which macro-level factors currently influence the heterogeneous approaches. This review used the scientific research databases Medline and CINAHL in April 2025. It included studies, opinion papers, and book chapters in English and German offering explanations, analysis, discussion, and examples of macro-level clinical ethics support structures' adoption and implementation influences. An inductive qualitative content analysis was conducted to extract the desired information. The resulting categories were formatted into an overview frame. The literature search yielded 400 publications, full-text analysis and snowball search resulted in 47 eligible for analysis. Eight main factors with respective subcategories were identified. These vary in their degree of binding authority, ranging from clearly defined regulations, such as national laws, to more ambiguous influences, such as public opinion and advocacy. Further insights reveal that the effectiveness of these factors cannot yet be determined, and their influence may vary based on the values and political context of the country where a support structure is implemented.