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

Abstract

<jats:title>Abstract</jats:title> <jats:p>Background Clinical Ethics Support (CES) services are offered to support healthcare professionals in dealing with ethically difficult situations. Evaluation of CES is important to understand if it is indeed a supportive service in order to inform and improve future implementation of CES. Yet, methods to measure outcomes of CES are scarce. In 2014, the European Moral Case Deliberation Outcomes Instrument (Euro-MCD) was developed to measure outcomes of Moral Case Deliberation (MCD). To further validate the instrument, we tested it in field studies and revised it. This paper presents the Euro-MCD 2.0 and describes the revision process.Methods The revision process comprised an iterative dialogue among the authors as Euro-MCD-project team, including empirical findings from six Euro-MCD field-studies and input from European experts in CES and theory. Empirical findings contained perceptions and experiences of MCD outcomes among healthcare professionals who participated in MCDs in various settings in Norway, Sweden and the Netherlands. Theoretical viewpoints on CES, literature on goals of CES and MCD and ethics theory guided the interpretation of the empirical findings and final selection of MCD outcomes.Results The Euro-MCD 2.0 Instrument includes three domains: Moral Competence, Moral Teamwork and Moral Action. Moral Competence consists of items about moral sensitivity, analytical skills and virtuous attitude. Moral Teamwork includes open dialogue and supportive relationships and Moral Action refers to moral decision-making and responsible care. During the revision process, we made decisions about adding and reformulating items as well as decreasing the number from 26 to 15 items. We also altered the sentence structure of items to assess the current status of outcomes (e.g. ‘now’) instead of an assumed improvement over time (e.g. ‘better’) and we omitted the question about perceived importance.Conclusions : The Euro-MCD 2.0 is shorter, less complex and more strongly substantiated by an integration of empirical findings, theoretical reflections and dialogues with participants and experts. Use of the Euro-MCD 2.0 will facilitate evaluation of MCD and can thereby monitor and foster implementation and quality of MCD. The Euro-MCD 2.0 will strengthen future research on evaluation of outcomes of MCD.</jats:p>

The Contribution of Moral Case Deliberation to Teaching RCR to PhD Students

“…Currently, no data are available on the use of MCD in RCR education, but MCD is an established tool in the clinical setting aiming to increase moral competence, teamwork and action, and has also been evaluated in this context, showing effectiveness in relation to learning outcomes (Stolper et al 2016 ; Haan et al, 2018 ; Snoo-Trimp et al, 2020a , 2020b ). There is consistent evidence that in the field of healthcare, MCD is effective in enhancing professionals’ willingness and abilities to recognize ethical issues and to engage in conversations about them with their colleagues (Snoo-Trimp et al, 2020a , 2020b ). MCD has been shown to provide participants with the tools necessary to successfully navigate personal cases and dilemmas (Stolper et al, 2016 ; de Snoo-Trimp et al, 2020a , 2020b ).…”

“…There is consistent evidence that in the field of healthcare, MCD is effective in enhancing professionals’ willingness and abilities to recognize ethical issues and to engage in conversations about them with their colleagues (Snoo-Trimp et al, 2020a , 2020b ). MCD has been shown to provide participants with the tools necessary to successfully navigate personal cases and dilemmas (Stolper et al, 2016 ; de Snoo-Trimp et al, 2020a , 2020b ). First, it makes participants postpone judgments, creating a safe space to discuss sensitive issues, as well as the possibility for co-creating strategies to overcome RCR issues and share advice and peer support (Inguaggiato et al, 2019 ).…”