Department of Ethics, Law and Humanities, Amsterdam UMC, VU University, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.
Department IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
BMC Med Ethics. 2022 Feb 5;23(1):10. doi: 10.1186/s12910-022-00747-2.
As moral case deliberations (MCDs) have increasingly been implemented in health care institutions as a form of ethics support, it is relevant to know whether and how MCDs actually contribute to positive changes in care. Insight is needed on what actually happens in daily care practice following MCD sessions. This study aimed at investigating the impact of MCD and exploring how 'impact of MCD' should be conceptualized for future research.
A multiple-case study was conducted in a care organization for people with intellectual disabilities and/or acquired brain injury, by observing MCD sessions as 'cases', followed by interviews with health care professionals concerning the follow-up to these cases, and a focus group with involved MCD facilitators. A conceptual scheme concerning the possible impact formed the basis for analysis: (1) individual moral awareness; (2) the actions of health care professionals; (3) collaboration among health care professionals; (4) the concrete situation of the client; (5) the client's quality of care and life; (6) the organizational and policy level.
According to interviewees, their moral awareness and their collaboration, both among colleagues and with clients' relatives, improved after MCD. Perceived impact on client situation, quality of care/life and the organizational level varied among interviewees or was difficult to define or link to MCD. Three aspects were added to the conceptual scheme concerning the impact of MCD: (a) preparations and expectations prior to the MCD session; (b) a translational step between the conclusions of the MCD session and practical events in the following period, and (c) collaboration with clients' relatives. A negative impact of MCD was also found on misunderstandings among participants and disappointment about lack of follow-up.
Concretizing and conceptualizing the 'impact' of MCD is complicated as many factors play a role either before or during the transition from MCD to practice. It is important to consider 'impact' in a broad sense and to relate it to the goals and context of the MCD in question. Future studies in this field should pay additional attention to the preparations, content and process involved in ethics support, including clients' and relatives' experiences.
随着道德案例审议（MCD）作为一种伦理支持形式越来越多地在医疗机构中实施，了解 MCD 是否以及如何实际促进护理的积极变化就变得很重要。需要了解在 MCD 会议之后的日常护理实践中实际发生了什么。本研究旨在调查 MCD 的影响，并探讨如何为未来的研究概念化“MCD 的影响”。
在一家为智力残疾和/或后天性脑损伤患者提供护理的机构中进行了一项多案例研究，将 MCD 会议作为“案例”进行观察，随后对医疗保健专业人员进行了访谈，了解这些案例的后续情况，并与参与 MCD 促进者进行了焦点小组讨论。一个关于可能影响的概念框架构成了分析的基础：（1）个人道德意识；（2）医疗保健专业人员的行动；（3）医疗保健专业人员之间的合作；（4）客户的具体情况；（5）客户的护理质量和生活；（6）组织和政策层面。
根据受访者的说法，他们的道德意识以及他们之间的合作，无论是同事之间还是与客户亲属之间，在 MCD 之后都有所改善。对客户情况、护理/生活质量和组织层面的感知影响因受访者而异，或者难以定义或与 MCD 联系起来。该概念框架中增加了 MCD 影响的三个方面：（a）在 MCD 会议之前的准备和期望；（b）MCD 会议的结论与后续期间实际事件之间的翻译步骤；（c）与客户亲属的合作。MCD 还对参与者之间的误解和对缺乏后续行动的失望产生了负面影响。
具体说明和概念化 MCD 的“影响”很复杂，因为在从 MCD 过渡到实践的过程中，有许多因素在起作用。重要的是要从更广泛的意义上考虑“影响”，并将其与 MCD 的目标和背景联系起来。该领域的未来研究应更加关注伦理支持所涉及的准备、内容和过程，包括客户和亲属的经验。
