Outcomes of moral case deliberation--the development of an evaluation instrument for clinical ethics support (the Euro-MCD).
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.
Centre for Health Care Sciences, Örebro University hospital and School of Health and Medical Sciences, Örebro university, Örebro, Sweden. mia.svantesson@orebroll.se.
Mia
M
Svantesson
Jan
J
Karlsson
Pierre
P
Boitte
Jan
J
Schildman
Linda
L
Dauwerse
Guy
G
Widdershoven
Reidar
R
Pedersen
Martijn
M
Huisman
Bert
B
Molewijk
D003697:Delphi Technique; D033061:Ethics Consultation / Q000458:organization & administration; D026690:Ethics, Clinical; D005060:Europe; D005260:Female; D006126:Group Processes; D006282:Health Personnel / Q000941:ethics*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D009014:Morals; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D011787:Quality of Health Care / Q000941:ethics*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires