Clinical ethics guideline METAP - evaluation, methodological foundation and improvement

Project summary: The allocation of medical and nursing care at the bedside (micro-allocation) has become an area of tension: cost pressure contributes to the risk of under-treatment or discrimination, whereas uncritical use of high-tech medicine increases the risk of over-treatment. With the help of previous SNF support we have developed an instrumentarium for health care professionals; it aims at helping in the search for an ethically appropriate treatment decision in difficult situations. The clinical ethical guideline METAP (Modular Ethical Treatment Allocation Process) is a comprehensive tool with procedural rules and practical aids for the clinical target groups. Moreover, with METAP we define and describe a concept which includes a scientifically based methodology for the development of clinical ethical guidelines. Both, the guideline and the methodological procedure will undergo a thorough interdisciplinary evaluation study and ensuing improvement.

We have developed METAP systematically orienting at evidence-based medical guideline programs and thorough literature searches. METAP relies on an escalating model (steps 1-4) with different forms of support for clinical staff seeking advice in making difficult treatment decisions. As part of the planned project, it will be introduced, evaluated, and optimized on additional clinical units for independent assessment which is a methodological requirement for its improvement and legitimization. Contrary to medical guidelines no recommendations exist regarding the development, implementation and evaluation of clinical-ethical guidelines. We will investigate and improve the METAP instrumentarium through an interdisciplinary evaluation strategy, by methodological and theoretical foundation.

As a "minimal outcome" we expect an increase of ethical reflection and mutual exchange among those involved on how the goals of more fairness and transparency can be realized in clinical routine. It might be, that different institutions will benefit more or less from working with our instrument, or even lack the prerequisites to do so.

The project integrates the potential of clinical ethics support in general and raises and responds to specific challenges such as fair and transparent micro-allocation in complex treatment decisions and difficult situations. As an integrative approach offering a variety of problem solving strategies it also addresses conceptual issues of clinical ethics support and opens the door towards a broad capacity-building program to enhance ethical competence among health care professionals.