Clinical ethics support (CES) instruments are widely regarded as valuable tools; however, users frequently encounter barriers to their routine use. Involving end users and other stakeholders in the development of CES instruments may help address these challenges. This study outlines the creation of CURA, a user-friendly, four-step ethics support tool designed for nurses and nurse assistants in palliative care. A participatory development approach was employed, involving collaboration with stakeholders through a Community of Practice across the study. Potential end users—nurses and nurse assistants in palliative care—tested CURA in multiple pilot sessions, providing feedback that informed successive refinements of the instrument. The development process was divided into three phases. Phase one, Identifying Needs, concentrated on understanding the preferences and requirements of stakeholders and end users, analyzing existing CES instruments, and identifying gaps in current tools. Phase two, Development, involved iterative co-creation to design, refine, and adapt the instrument. Phase three, Dissemination, focused on implementation and distribution strategies. CURA emerged as a four-step, low-threshold tool that facilitates structured ethical reflection. The participatory development approach proved effective for designing clinical ethics support instruments. Collaboration with end users and stakeholders allowed for better alignment with their needs, informed strategies for improving feasibility, and helped overcome limitations observed in existing CES tools.
