Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
Geriatrics, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.
BMJ Qual Saf. 2018 Oct;27(10):781-789. doi: 10.1136/bmjqs-2017-007390. Epub 2018 Feb 23.
Literature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU).
To better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates.
Using a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment. This instrument was subsequently validated among clinicians working in 68 adult ICUs in 13 European countries and the USA. Exploratory and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians. Measurement invariance was tested to make sure that variables used in the analysis were comparable constructs across different groups.
Of 3610 nurses and 1137 physicians providing ICU bedside care, 2275 (63.1%) and 717 (62.9%) participated respectively. Statistical analyses revealed that a shortened 32-item version of the EDMCQ scale provides a factorial valid measurement of seven facets of the extent to which clinicians perceive an EDM climate: self-reflective and empowering leadership by physicians; practice and culture of open interdisciplinary reflection; culture of not avoiding end-of-life decisions; culture of mutual respect within the interdisciplinary team; active involvement of nurses in end-of-life care and decision-making; active decision-making by physicians; and practice and culture of ethical awareness. Measurement invariance of the EDMCQ across occupational groups was shown, reflecting that nurses and physicians interpret the EDMCQ items in a similar manner.
The 32-item version of the EDMCQ might enrich the EDM climate measurement, clinicians' behaviour and the performance of healthcare organisations. This instrument offers opportunities to develop tailored ICU team interventions.
文献描绘了不同国家和重症监护病房（ICU）之间在伦理决策（EDM）方面的差异。
更好地概念化 ICU 中的 EDM 氛围，并验证一种评估 EDM 氛围的工具。
我们使用改良 Delphi 方法构建了一个理论框架和一个由 35 个陈述组成的自我评估工具。这个伦理决策氛围问卷（EDMCQ）旨在捕捉医疗保健中的三个 EDM 领域：跨学科合作和沟通；医生的领导能力；和伦理环境。该工具随后在 13 个欧洲国家和美国的 68 个成人 ICU 中的临床医生中进行了验证。探索性和验证性因素分析用于确定临床医生感知的 EDM 氛围结构。测试测量不变性以确保分析中使用的变量在不同组之间是可比的结构。
在提供 ICU 床边护理的 3610 名护士和 1137 名医生中，分别有 2275 名（63.1%）和 717 名（62.9%）参与。统计分析表明，EDMCQ 量表的缩短 32 项版本提供了一个因素有效测量的临床医生感知的 EDM 氛围的七个方面：医生的自我反思和赋权领导；开放的跨学科反思的实践和文化；不回避临终决策的文化；跨学科团队内相互尊重的文化；护士积极参与临终关怀和决策；医生积极决策；以及实践和伦理意识的文化。EDMCQ 在职业群体之间的测量不变性表明，护士和医生以类似的方式解释 EDMCQ 项目。
EDMCQ 的 32 项版本可能会丰富 EDM 氛围的测量、临床医生的行为和医疗保健组织的绩效。该工具为开发针对 ICU 团队的干预措施提供了机会。
