What Outcomes do Dutch Healthcare Professionals Perceive as Important Before Participation in Moral Case Deliberation?

Snoo-Trimp, Janine de; Widdershoven, Guy; Svantesson, Mia; Vet, Henrica C.W. de; Molewijk, Bert

doi:10.1111/bioe.12354

Cited by 29 publications

(61 citation statements)

References 2 publications

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“…Moreover, one could suggest that the ndings from a Dutch study designed in a comparable way [29] described themes both similar and different to those in this study. The authors of that study present Beerteamw or k´∈ clud ∈ gimp or tantoutcomeslikeMore open communication´ and `Better mutual understanding´ in a similar manner to our theme: Interprofessional well-being including Permissive dialogue and Interprofessional understanding.…”

Section: Discussionsupporting

confidence: 44%

Perceptions of important outcomes of moral case deliberations: a qualitative study among healthcare professionals in childhood cancer care

Weiner

Pergert

Molewijk

et al. 2020

Preprint

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BACKGROUND: In childhood cancer care, healthcare professionals must deal with several difficult moral situations in clinical practice. Previous studies show that morally difficult challenges are related to decisions on treatment limitations, infringing on the child's integrity and growing autonomy, and interprofessional conflicts. Research also shows that healthcare professionals want ethics support to help them deal with morally difficult situations. Moral case deliberations (MCDs) are one example of ethics support. The aim of this study was to describe MCD related outcomes that HCPs in childhood cancer care considered important to achieve, before MCDs were implemented, in order to support them in handling moral challenges in every day clinical practice.METHODS: This study is based on qualitative data. Healthcare professionals, mostly representing registered nurses, nursing assistants and physicians, working at childhood cancer care centres in Sweden, were invited to respond to the translated and content-validated European Moral Case Deliberation questionnaire, before participating in regular MCDs. The main open-ended question included in the questionnaire was analysed according to systematic text condensation. RESULTS: Data was collected from 161 responses from the healthcare professionals who were invited to participate. The responses included healthcare professionals’ perceptions of which MCD-related outcomes they found important for handling moral challenges. Three different themes of important outcomes from the analysis of the data are presented as follows: Inter-professional wellbeing, Being in a professional comfort zone, and Improved quality of care. The themes are related to teams, individuals and care, respectively.CONCLUSIONS: Healthcare professionals in childhood cancer care considered it important that ethics support could enhance the well-being of interprofessional teams, support healthcare professionals on an individual level and improve quality of care. The results of this study can be used for information in future training for MCD-facilitators. When knowing the context specific important MCD-outcomes, the sessions could be adapted. Managers in childhood cancer care would benefit from knowing about the specific important outcomes for their target group because they could then tailor the conditions. Finally, this study contributes to the reflection upon and evaluation of appropriate CESS outcomes in general.

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Section: Discussionsupporting

confidence: 44%

Perceptions of important outcomes of moral case deliberations: a qualitative study among healthcare professionals in childhood cancer care

Weiner

Pergert

Molewijk

et al. 2020

Preprint

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“…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.…”

Section: Methodsmentioning

confidence: 99%

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

Silén

Svantesson

2019

J Nurs Manag

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Aim To explore first‐line managers’ experiences of what Moral Case Deliberation has meant for daily practice, to describe perceptions of context influence and responsibility to manage ethically difficult situations. Background In order to find measures to evaluate Moral Case Deliberation, the European Moral Case Deliberation Outcome instrument was developed and is now in the stage of revision. For this, there is a need of several perspectives, one of them being the managerial bird‐eye perspective. Method Eleven first‐line managers at workplaces, participating in the European Moral Case Deliberation Outcome instrument project, were interviewed and thematic analysis was applied. Results Managers’ experiences were interpreted as enhanced ethical climate: a closer‐knit and more emotionally mature team, morally strengthened individuals, as well as ethics leaving its marks on everyday work and morally grounded actions. Despite organizational barriers, they felt inspired to continue ethics work. Conclusion and Implications This study confirmed, but also added ethical climate aspects, such as morally grounded actions. Furthermore, adding ethical climate as a construct in the European Moral Case Deliberation Outcome instrument should be considered. First‐line managers need clear directives from their managers that ethics work needs to be prioritized for the good of both the staff and the patients.

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“…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.…”

Section: Various Empirical Data Sources and Normative Reasoning Determentioning

confidence: 99%

“…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.…”

Section: Future Perspectivesmentioning

confidence: 99%

“…So far, data about perceived importance of outcomes by healthcare professionals before their participation in MCD have been published. 19,20 The ultimate purpose of the larger field study is to test and further develop the Euro-MCD Instrument for use in clinical practice and future evaluation research. Exploring correlations of outcomes of the instrument can inform possible categorization of outcomes.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Background: Moral case deliberation is a form of clinical ethics support to help healthcare professionals in dealing with ethically difficult situations. There is a lack of evidence about what outcomes healthcare professionals experience in daily practice after moral case deliberations. The Euro-MCD Instrument was developed to measure outcomes, based on the literature, a Delphi panel, and content validity testing. To examine relevance of items and adequateness of domains, a field study is needed. Aim: To describe experienced outcomes after participating in a series of moral case deliberations, both during sessions and in daily practice, and to explore correlations between items to further validate the Euro-MCD Instrument. Methods: In Sweden, the Netherlands, and Norway, healthcare institutions that planned a series of moral case deliberations were invited. Closed responses were quantitatively analyzed. The factor structure of the instrument was tested using exploratory factor analyses. Ethical considerations: The study was approved in Sweden by a review board. In Norway and the Netherlands, data services and review boards were informed about the study. Results: The Euro-MCD Instrument was completed by 443 and 247 healthcare professionals after four and eight moral case deliberations, respectively. They experienced especially outcomes related to a better collaboration with co-workers and outcomes about individual moral reflexivity and attitude, both during sessions and in daily practice. Outcomes were experienced to a higher extent during sessions than in daily practice. The factor structure revealed four domains of outcomes, which did not confirm the six Euro-MCD domains. Conclusion: Field-testing the Euro-MCD Instrument showed the most frequently experienced outcomes and which outcomes correlated with each other. When revising the instrument, domains should be reconsidered, combined with theory about underlying concepts. In the future, a feasible and valid instrument will be presented to get insight into how moral case deliberation supports and improves healthcare.

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What Outcomes do Dutch Healthcare Professionals Perceive as Important Before Participation in Moral Case Deliberation?

Cited by 29 publications

References 2 publications

Perceptions of important outcomes of moral case deliberations: a qualitative study among healthcare professionals in childhood cancer care

Perceptions of important outcomes of moral case deliberations: a qualitative study among healthcare professionals in childhood cancer care

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

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

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