University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Medical Humanities, VU Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
J Med Ethics. 2019 Sep;45(9):608-616. doi: 10.1136/medethics-2018-104745. Epub 2019 Jul 18.
There is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation (MCD). Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument (Euro-MCD) instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.
A North European field survey among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.
All outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%-97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. 'Better interactions with patient/family' emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.
The findings indicate a need for a broad instrument such as the Euro-MCD. Outcomes related to better interactions between professionals and patients must also be included in the future. The empirical findings raise the normative question of whether outcomes that were perceived as less important, such as reflexivity and attitude outcomes, should still be included. In the future, a combination of empirical findings (practice) and normative reflection (theories) will contribute to the revision of the instrument.
道德案例审议（MCD）等临床伦理支持方法的结果缺乏实证研究。需要对医疗保健专业人员如何看待潜在结果进行实证研究，以便评估伦理支持的价值和有效性，并有助于设计未来的结果研究。目的是使用欧洲道德案例审议结果工具（Euro-MCD）工具，根据医疗保健专业人员在参与之前对各种 MCD 结果的重要性进行评估。
在荷兰、挪威和瑞典的各种医疗保健环境中，从 73 个工作场所中抽取的医疗保健专业人员进行北欧实地调查。使用了 Euro-MCD 工具。
703 名受访者中，有 76%-97%的人认为所有关于道德反思、道德态度、情感支持、协作、对组织层面的影响和具体结果的领域的结果都是非常重要或相当重要的。关于协作和具体结果的结果被认为是最重要的。评估为不重要的结果主要与道德态度有关。从定性分析中出现了一个新的领域，即“更好地与患者/家属互动”。荷兰受访者认为大多数结果的重要性明显低于斯堪的纳维亚人，尤其是在情感支持方面。此外，男性、年轻和医生受访者对大多数结果的评分都明显低于其他受访者。
研究结果表明需要一种广泛的工具，如 Euro-MCD。未来还必须包括与专业人员和患者之间更好互动相关的结果。实证研究结果提出了一个规范性问题，即是否应该包括被认为不太重要的结果，例如反思和态度结果。未来，实证研究结果（实践）和规范性反思（理论）的结合将有助于该工具的修订。
