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

BMC Medical Ethics

Bert Molewijk⁷  Martijn Huisman³  Reidar Pedersen⁷  Guy Widdershoven¹  Linda Dauwerse¹  Jan Schildman⁴  Pierre Boitte²  Jan Karlsson⁵  Mia Svantesson⁶ 

[1] Institute for Health and Care Research,VU University Medical Center and Department of Sociology, VU University, Amsterdam, Netherlands;Centre of Medical Ethics, Department of Ethics, Catholic University of Lille, Lille, France;Department of Epidemiology & Biostatistics and the EMGO, Dep. Medical Humanities, Vumc & Emgo, Amsterdam, Netherlands;Institute for Medical Ethics and History of Medicine, NRW Junior Research Group “Medical Ethics at the End of Life: Norm and Empiricism”, Ruhr-University Bochum, Bochum, Germany;Department of Medicine, Örebro University Hospital, Örebro, Sweden;Karlskoga Hospital, Karlskoga, Sweden;Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway

关键词: Evaluation;    Instrument development;    Questionnaire;    Health care providers;    Ethics rounds;    Moral case deliberation;    Ethics consultation;    Clinical ethics support;    Clinical ethics;   

Others  :  799551
DOI  :  10.1186/1472-6939-15-30

 received in 2013-06-27, accepted in 2014-03-21,  发布年份 2014

【 摘 要 】

Background

Clinical 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.

Methods

A 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.

Results

The 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.

Conclusions

A 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.

【 授权许可】

   
2014 Svantesson et al.; licensee BioMed Central Ltd.

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