Outcomes of Moral Case Deliberation - the development of an evaluation instrument for clinical ethics support (the Euro-MCD)

Abstract

BackgroundClinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome evaluation instrument. The aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers’ experiences and perceived importance of outcomes of Moral Case Deliberation.MethodsA multi-item instrument for assessing outcomes of Moral Case Deliberation (MCD) was constructed through an iterative process, founded on a literature review and modified through a multistep review by ethicists and health care providers. The instrument measures perceived importance of outcomes before and after MCD, as well as experienced outcomes during MCD and in daily work. A purposeful sample of 86 European participants contributed to a Delphi panel and content validity testing. The Delphi panel (n = 13), consisting of ethicists and ethics researchers, participated in three Delphi-rounds. Health care providers (n = 73) participated in the content validity testing through ‘think-aloud’ interviews and a method using Content Validity Index.ResultsThe development process resulted in the European Moral Case Deliberation Outcomes Instrument (Euro-MCD), which consists of two sections, one to be completed before a participant’s first MCD and the other after completing multiple MCDs. The instrument contains a few open-ended questions and 26 specific items with a corresponding rating/response scale representing various MCD outcomes. The items were categorised into the following six domains: Enhanced emotional support, Enhanced collaboration, Improved moral reflexivity, Improved moral attitude, Improvement on organizational level and Concrete results.ConclusionsA tentative instrument has been developed that seems to cover main outcomes of Moral Case Deliberation. The next step will be to test the Euro-MCD in a field study.

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

“…Eleven Swedish first‐line managers at workplaces that had conducted MCD meetings in the Euro‐MCD project (de Snoo‐Trimp, Widdershoven, Svantesson, de Vet, & Molewijk, ; Heidenreich et al, ; Rasoal et al, ; Svantesson et al, , ) were included (Table ). They had participated in MCD meetings at 10 audio‐recorded Swedish workplaces and agreed to be interviewed; at one workplace, the assistant manager also volunteered for an interview and was interviewed together with the first‐line manager.…”

“…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, ). 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.…”

Refleksjonsgrupper i etikk: «Pusterom» eller læringsarena?

“…Tilbud om systematisk etikkrefleksjon har blitt etablert på sykehus i flere land, blant annet gjennom kliniske etikk-komiteer og moral case deliberation Førde & Vandvik 2005;Molewijk et al 2008;Svantesson et al 2014). Studier viser at slike tiltak fører til bedret kommunikasjon, stimulerer til ferdigheter i kritisk tenkning og øker den enkeltes etiske kompetanse (Kalager et al 2011;Weidema et al 2013).…”

Retour de la contention en psychiatrie : perception des patients et soignants et considérations éthiques

“…Les « moral case deliberations », mises en place dans les pays anglo-saxons et aux Pays-Bas, réunissent des professionnels d'horizons différents [27,28], du champ sanitaire mais aussi des juristes, philosophes, des travailleurs sociaux. Elles offrent la possibilité, en dehors du temps et parfois du lieu de travail, de réfléchir et de délibérer sur une question éthique [26,28] soulevée par un cas rapporté par un soignant et discutée en réunion [26].…”