de Snoo-Trimp Janine C, Molewijk Bert, de Vet Henrica C W
Department of Medical Humanities, Amsterdam University Medical Centers location VUmc, Amsterdam, the Netherlands.
Center for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
BMC Med Ethics. 2018 Nov 19;19(1):88. doi: 10.1186/s12910-018-0324-z.
To 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.
The 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.
The 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.
This 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.
为了帮助医疗保健专业人员应对伦理困境，诸如道德案例审议（MCD）之类的临床伦理支持（CES）服务越来越多地得到实施。为了评估CES的影响，评估结果很重要。尽管MCD专家对结果有一般性的说法，并且有一些定性研究，但尚未对结果进行概念分析。因此，本研究的目的是系统地定义和分类MCD结果。另一个目的是将这些结果与2014年欧洲MCD工具中的结果进行比较，以进一步验证该工具。
采用概念映射方法，该方法涉及定性和定量步骤，包括头脑风暴、个体结构化、概念图计算（通过主成分分析和聚类分析）、小组解释和利用。共有12名来自不同专业背景的经验丰富的MCD参与者参加了两次会议。
焦点小组头脑风暴产生了一份包含85种可能的MCD结果的清单，并据此构建了点图和概念图。在对每个聚类进行深入讨论后，就MCD结果的8个聚类的名称和位置达成了最终共识：1）组织与政策；2）团队发展；3）关注他人的个人发展；4）作为专业人员的个人发展，关注技能；5）作为专业人员的个人发展，关注知识；6）作为个体的个人发展；7）认知与联系；8）具体行动。
本研究在概念映射焦点小组中探索并分类了MCD结果。将结果与欧洲MCD工具进行比较时，我们的研究证实，MCD结果可以分为涉及组织层面、团队发展、个人发展（作为个体和专业人员）以及具体案例层面的聚类。在开发CES评估工具时，重要的是要明确结果是指个人还是团队、知识还是技能、组织还是特定案例。这些发现将用于欧洲MCD工具的进一步验证。本研究进一步推动了一般CES评估领域的发展，尤其有助于明确MCD的结果。
