Important outcomes of moral case deliberation: a Euro-MCD field survey of healthcare professionals’ priorities

Abstract

BackgroundThere is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation (MCD). Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument (Euro-MCD) instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.MethodsA North European field survey among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.ResultsAll outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%–97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. ‘Better interactions with patient/family’ emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.ConclusionsThe findings indicate a need for a broad instrument such as the Euro-MCD. Outcomes related to better interactions between professionals and patients must also be included in the future. The empirical findings raise the normative question of whether outcomes that were perceived as less important, such as moral reflexivity and moral attitude outcomes, should still be included. In the future, a combination of empirical findings (practice) and normative reflection (theories) will contribute to the revision of the instrument.

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

“…Developing a measurement instrument for outcomes of a clinical ethics supportive intervention like MCD is a complex (but highly needed) process. 24 For the revision of the Euro-MCD instrument, various empirical findings from different field studies 12,19,20,[25][26][27][28] should be combined with conceptual and normative discussions on what outcomes should be included based on the (theoretically described) goals of MCD. The main relevance of the factor analysis as done in the current study is that it informs us about the correlations among items and about what possible clustering of items would be meaningful in the sense that items indeed refer to the same underlying construct.…”

“…The findings on the experienced outcomes and the factor structure add to the data from other Euro-MCD field studies to further validate and revise the Euro-MCD Instrument. 12,19,20,[25][26][27][28] Other ongoing field studies include the perceived importance of the outcomes (by healthcare participants) after MCD participation, the facilitator's role, and the manager's views on impact. In the overall process of developing a new Euro-MCD instrument, which is currently taken place, the empirical evidence will be combined with normative reflections by the research team, ethics experts as well as healthcare professionals from the field.…”

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

“…In the present study, which is part of the larger Euro‐MCD project (, observational design is applied. This in order to capture different perspectives on outcomes (de Snoo‐Trimp, Molewijk, & Vet, ; Svantesson et al, , in press) and content of MCD (Heidenreich, Bremer, Materstvedt, Tidefelt, & Svantesson, ; Rasoal et al, ; Svantesson, Silén, & James, ) in different existing MCD practices, for development of the Euro‐MCD instrument (Svantesson et al, ). So far, the Euro‐MCD project has generated potential outcomes of MCD regarding emotional support, collaboration, moral reflexivity, moral attitude, concrete results and improvement on organizational level (Svantesson et al, ).…”

“…So far, the Euro‐MCD project has generated potential outcomes of MCD regarding emotional support, collaboration, moral reflexivity, moral attitude, concrete results and improvement on organizational level (Svantesson et al, ). These outcomes are now under revision after results from field‐studies (, in press) and perspectives of those involved (Rasoal, Kihlgren, & Svantesson, ), where first‐line managers’ bird‐eye perspective is an important source.…”

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

“…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.…”