Defining and categorizing outcomes of Moral Case Deliberation (MCD): concept mapping with experienced MCD participants

Abstract

BackgroundTo support healthcare professionals in dealing with ethically difficult situations, Clinical Ethics Support (CES) services like Moral Case Deliberation (MCD) are increasingly implemented. To assess the impact of CES, it is important to evaluate outcomes. Despite general claims about outcomes from MCD experts and some qualitative research, there exists no conceptual analysis of outcomes yet. Therefore, the aim of this study was to systematically define and categorize MCD outcomes. An additional aim was to compare these outcomes with the outcomes in the Euro-MCD Instrument from 2014, to further validate this Instrument.MethodsThe concept mapping method was used and involves qualitative and quantitative steps including brainstorming, individual structuring, computation of concept maps (by principal component analysis and cluster analysis), group interpretation and utilization. In total, 12 experienced MCD participants from a variety of professional backgrounds participated in two sessions.ResultsThe focus group brainstorm resulted in a list of 85 possible MCD outcomes, of which a point map and concept maps were constructed. After a thorough discussion of each cluster, final consensus was reached on the names and position of 8 clusters of MCD outcomes: 1) Organisation and Policy; 2) Team development; 3) Personal development focused on the Other Person; 4) Personal development as Professional, focused on Skills; 5) Personal development as Professional, focused on Knowledge; 6) Personal development as an Individual; 7) Perception and Connection; and 8) Concrete action.ConclusionsThis study explored and categorized MCD outcomes in a concept mapping focus group. When comparing the results with the Euro-MCD Instrument, our study confirms that outcomes of MCD can be categorized in clusters referring to the organisational level, team development, personal development (both as an individual and a professional) and the concrete case-level. In developing CES evaluation tools, it is important to be explicit if an outcome refers to the individual or the team, to knowledge or skills, to the organisation or the specific case. The findings will be used in the further validation of the Euro-MCD Instrument. The current study further contributes to the field of evaluating CES in general and defining outcomes of MCD in particular.Electronic supplementary materialThe online version of this article (10.1186/s12910-018-0324-z) contains supplementary material, which is available to authorized users.

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, ).…”

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

“…In all eld studies, participation was voluntary and based on informed consent. More details regarding recruitment procedures and respondents' characteristics can be found elsewhere [20][21][22][23][24][25].…”

“…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.…”