Impact of moral case deliberation in healthcare settings: a literature review

Abstract

BackgroundAn important and supposedly impactful form of clinical ethics support is moral case deliberation (MCD). Empirical evidence, however, is limited with regard to its actual impact. With this literature review, we aim to investigate the empirical evidence of MCD, thereby a) informing the practice, and b) providing a focus for further research on and development of MCD in healthcare settings.MethodsA systematic literature search was conducted in the electronic databases PubMed, CINAHL and Web of Science (June 2016). Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of our decisions. The qualitative analysis was supported by ATLAS.ti.ResultsBased on a qualitative analysis of 25 empirical papers, we identified four clusters of themes: 1) facilitators and barriers in the preparation and context of MCD, i.e., a safe and open atmosphere created by a facilitator, a concrete case, commitment of participants, a focus on the moral dimension, and a supportive organization; 2) changes that are brought about on a personal and inter-professional level, with regard to professional’s feelings of relief, relatedness and confidence; understanding of the perspectives of colleagues, one’s own perspective and the moral issue at stake; and awareness of the moral dimension of one’s work and awareness of the importance of reflection; 3) changes that are brought about in caring for patients and families; and 4) changes that are brought about on an organizational level.ConclusionsThis review shows that MCD brings about changes in practice, mostly for the professional in inter-professional interactions. Most reported changes are considered positive, although challenges, frustrations and absence of change were also reported. Empirical evidence of a concrete impact on the quality of patient care is limited and is mostly based on self-reports. With patient-focused and methodologically sound qualitative research, the practice and the value of MCD in healthcare settings can be better understood, thus making a stronger case for this kind of ethics support.

Impact of clinical ethics support on daily practice—First‐line managers’ experiences in the Euro‐MCD project

“…Furthermore, we also lack this in HECS’ dimensions, but one item seems to resemble morally grounded actions: “The feelings and values of all parties involved in a patient care issue/problem are taken into account when choosing a course of actions” (Olson, ). The managers’ experience that staff were better prepared and took greater responsibility for handling ethical issues has also been reported by others (Haan et al, ).…”

“…A review (Haan, Gurp, Naber, & Grouenwoud, ) on the impact of MCD in healthcare settings found that healthcare staff felt relieved having the opportunity to talk to others about ethical issues and this created a sense of togetherness among the participants and improved interprofessional collaboration. MCD has also been shown to have an impact on different aspects of understanding.…”

“…Increased awareness of the ethical dimensions of work has also been described as well as the need to have possibilities to reflect on those. However, there is little evidence that these professional and interprofessional changes have a concrete impact on patient care (Haan et al, ). When MCD has been used as an intervention no statistically significant differences before and after MCD have been reported for measures of ethical climate (Silén et al, ) or moral distress (Kälvemark Sporrong, Arnetz, Hansson, Westerholm, & Höglund, ).…”

Women desiring less care than recommended during childbirth: Three years of dedicated clinic

“…6 This meeting is chaired by a member of the hospital ethics staff, and all maternity care team members, including the community midwife, are invited. 6 This meeting is chaired by a member of the hospital ethics staff, and all maternity care team members, including the community midwife, are invited.…”

“…If an agreement is reached which is deemed a challenge for the maternity department team, a "moral case deliberation" is called. 6 This meeting is chaired by a member of the hospital ethics staff, and all maternity care team members, including the community midwife, are invited. The woman and her partner are invited to present their wishes to the team and answer a few questions.…”