title: Evaluation and perceived results of moral case deliberation: A mixed methods study.
abstract: BACKGROUND
  Moral case deliberation is increasingly becoming part of various Dutch healthcare organizations. Although some evaluation studies of moral case deliberation have been carried out, research into the results of moral case deliberation within aged care is scarce.
  
  
  OBJECTIVE
  How did participants evaluate moral case deliberation? What has moral case deliberation brought to them? What has moral case deliberation contributed to care practice? Should moral case deliberation be further implemented and, if so, how?
  
  
  METHODS
  Quantitative analysis of a questionnaire study among participants of moral case deliberation, both caregivers and team leaders. Qualitative analysis of written answers to open questions, interview study and focus group meetings among caregivers and team leaders.
  
  
  METHODS
  Caregivers and team leaders in a large organization for aged care in the Netherlands. A total of 61 moral case deliberation sessions, carried out on 16 care locations belonging to the organization, were evaluated and perceived results were assessed.
  
  
  METHODS
  Participants gave informed consent and anonymity was guaranteed. In the Netherlands, the law does not prescribe independent ethical review by an Institutional Review Board for this kind of research among healthcare professionals.
  
  
  RESULTS
  Moral case deliberation was evaluated positively by the participants. Content and atmosphere of moral case deliberation received high scores, while organizational issues regarding the moral case deliberation sessions scored lower and merit further attention. Respondents indicated that moral case deliberation has the potential to contribute to care practice as relationships among team members improve, more openness is experienced and more understanding for different perspectives is fostered. If moral case deliberation is to be successfully implemented, top-down approaches should go hand in hand with bottom-up approaches.
  
  
  CONCLUSIONS
  The relevance of moral case deliberation for care practice received wide acknowledgement from the respondents. It can contribute to the team's cohesion as mutual understanding for one another's views is fostered. If implemented well, moral case deliberation has the potential to improve care, according to the respondents.
authors.affiliation: VU University Medical Center EMGO+, The Netherlands mjpa.janssens@vumc.nl.
authors.forename: Rien M J P A
authors.initials: RM
authors.lastname: Janssens
authors.affiliation: Zuyd University of Applied Sciences, The Netherlands.
authors.forename: Ezra
authors.initials: E
authors.lastname: van Zadelhoff
authors.affiliation: Moral Case Deliberation Committee at Sevagram, Organisation for Elderly Care, The Netherlands.
authors.forename: Ger
authors.initials: G
authors.lastname: van Loo
authors.affiliation: VU University Medical Center EMGO+, The Netherlands.
authors.forename: Guy  A M
authors.initials: G
authors.lastname: Widdershoven
authors.affiliation: VU University Medical Center EMGO+, The Netherlands; University of Oslo, Centre for Medical Ethics, Norway.
authors.forename: Bert A C
authors.initials: BA
authors.lastname: Molewijk
mesh_terms: D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology*; D033061:Ethics Consultation; D004993:Ethics, Nursing; D017144:Focus Groups; D006707:Homes for the Aged / Q000941:ethics*; D006801:Humans; D009014:Morals; D009426:Netherlands; D015403:Nursing Evaluation Research; D009735:Nursing Homes / Q000941:ethics; D010348:Patient Care Team / Q000458:organization & administration; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: Clinical ethics; aged care; clinical ethics support; evaluation; moral case deliberation