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

Guy Schofield*, Emer Brangan, Mariana Dittborn, Richard Huxtable, Lucy Selman

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)

136 Downloads (Pure)



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.

PROSPERO Registration number: CRD42018105365
Original languageEnglish
Article numbere028480
Pages (from-to)e028480
Number of pages6
JournalBMJ Open
Issue number5
Publication statusPublished - 27 May 2019


Bibliographical note

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.


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

Cite this