Field-testing the Euro-MCD Instrument: Experienced outcomes of moral case deliberation

Abstract

Background: Moral case deliberation is a form of clinical ethics support to help healthcare professionals in dealing with ethically difficult situations. There is a lack of evidence about what outcomes healthcare professionals experience in daily practice after moral case deliberations. The Euro-MCD Instrument was developed to measure outcomes, based on the literature, a Delphi panel, and content validity testing. To examine relevance of items and adequateness of domains, a field study is needed. Aim: To describe experienced outcomes after participating in a series of moral case deliberations, both during sessions and in daily practice, and to explore correlations between items to further validate the Euro-MCD Instrument. Methods: In Sweden, the Netherlands, and Norway, healthcare institutions that planned a series of moral case deliberations were invited. Closed responses were quantitatively analyzed. The factor structure of the instrument was tested using exploratory factor analyses. Ethical considerations: The study was approved in Sweden by a review board. In Norway and the Netherlands, data services and review boards were informed about the study. Results: The Euro-MCD Instrument was completed by 443 and 247 healthcare professionals after four and eight moral case deliberations, respectively. They experienced especially outcomes related to a better collaboration with co-workers and outcomes about individual moral reflexivity and attitude, both during sessions and in daily practice. Outcomes were experienced to a higher extent during sessions than in daily practice. The factor structure revealed four domains of outcomes, which did not confirm the six Euro-MCD domains. Conclusion: Field-testing the Euro-MCD Instrument showed the most frequently experienced outcomes and which outcomes correlated with each other. When revising the instrument, domains should be reconsidered, combined with theory about underlying concepts. In the future, a feasible and valid instrument will be presented to get insight into how moral case deliberation supports and improves healthcare.

Moral competence, moral teamwork and moral action - the European Moral Case Deliberation Outcomes (Euro-MCD) Instrument 2.0 and its revision process

“…The Euro-MCD Instrument was tested in four field studies (De Snoo-Trimp J.C., Molewijk A.C., Svantesson M., Widdershoven G.A.M., De Vet H.C.W: Field-testing the Euro-MCD Instrument: Important outcomes according to participants before and after Moral Case Deliberation. Submitted) [20][21][22] and reflection on MCD outcomes in general was done in two additional studies [23,24] as shown in Table 1. With regards to the field studies, studies I-III involve answers of respondents to the question 'How important is this outcome according to you?…”

“…In all field studies, participation was voluntary and based on informed consent. More details regarding recruitment procedures and respondents' characteristics can be found elsewhere [20][21][22][23][24].…”

“…Recently, we conducted several field studies (see Table 1) using the Euro-MCD Instrument to assess whether healthcare professionals perceived the presented outcomes as important, to examine their experiences of outcomes and to examine the clustering of items of the instrument [20][21][22][23][24] (De Snoo-Trimp J.C., Molewijk A.C., Svantesson M., Widdershoven G.A.M., De Vet H.C.W: Field-testing the Euro-MCD Instrument: Important outcomes according to participants before and after Moral Case Deliberation. Submitted).…”

Moral Competence, Moral Teamwork and Moral Action – The European Moral Case Deliberation Outcomes (Euro-MCD) Instrument 2.0 and its revision process

“…In all eld studies, participation was voluntary and based on informed consent. More details regarding recruitment procedures and respondents' characteristics can be found elsewhere [20][21][22][23][24][25].…”

“…Recently, we conducted several eld studies (see Table 1) using the Euro-MCD Instrument to assess whether healthcare professionals perceived the presented outcomes as important, to examine their experiences of outcomes and to examine the clustering of items of the instrument [20][21][22][23][24][25]. Based on this process of eld-testing, time is ripe to present a revision of the Euro-MCD instrument.…”