How to Train and Assess the Quality of Facilitators for Moral Case Deliberation? Experiences with and Evaluation of Self-Reflection and Observation Forms for Facilitators of Moral Case Deliberation

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 170-170
Author(s):  
Margreet Stolper ◽  
◽  
Bert Molewijk ◽  
◽  
Keyword(s):  
International Health ◽  
Learning Goals ◽  
Moral Case Deliberation ◽  
Moral Inquiry ◽  
Self Reflection ◽  
Personal Learning ◽  
Ethics Support ◽  
Open Questions ◽  
Moral Case

"In Europe, Moral Case Deliberation (MCD) has been well-known and established as a form of Clinical Ethics Support (CES) and implemented in many international (health care) institutions. Since 2007 Amsterdam UMC organizes training for professionals to become a facilitator of MCD. To support and asses the development of those future facilitators MCD, an instrument has been developed which can be used by both trainees and trainers. The instrument consists of a self-reflection form and an observation form. Both forms are almost identical and contain a part of open questions reflecting upon the personal learning goals of the trainee and a part of 56 closed questions. The part of closed questions contains concrete descriptions of preferred skills and attitude of the MCD facilitator trainee, related to MCD in general and the specific steps of the Dilemma method and the Socratic Dialogue in particular. Special attention is being paid to concrete actions for fostering a dialogue and deepening the moral inquiry. The instrument can also be used by trained and more experienced facilitators of MCD to reflect upon their acquired skills and attitude, and indirectly on the quality of CES they provide. In this presentation we will present the instrument and share our experiences in using the two forms in order to train and assess (the quality of) facilitators of MCD. Furthermore, we will present preliminary results of the analysis of more than 1200 forms collected in the past decade from trainings on national and international level. "

scholarly journals Emotions and Clinical Ethics Support. A Moral Inquiry into Emotions in Moral Case Deliberation

HEC Forum ◽  
2011 ◽  
Vol 23 (4) ◽  
pp. 257-268 ◽  
Author(s):  
Bert Molewijk ◽  
Dick Kleinlugtenbelt ◽  
Scott M. Pugh ◽  
Guy Widdershoven
Keyword(s):  
Clinical Ethics ◽  
Moral Case Deliberation ◽  
Moral Inquiry ◽  
Clinical Ethics Support ◽  
Ethics Support ◽  
Moral Case

scholarly journals Perceptions of Important Outcomes of Ethics Case Reflection Rounds: A Qualitative Study among Healthcare Professionals in Childhood Cancer Care

2020 ◽  
Author(s):  
Charlotte Weiner ◽  
Pernilla Pergert ◽  
Bert Molewijk ◽  
Anders Castor ◽  
Cecilia Bartholdson
Keyword(s):  
Quality Of Care ◽  
Childhood Cancer ◽  
Cancer Care ◽  
Healthcare Professionals ◽  
Well Being ◽  
Moral Case Deliberation ◽  
Individual Level ◽  
Ethics Support ◽  
Moral Case

Abstract BACKGROUND: In childhood cancer care, healthcare professionals mustdeal with several difficult moral situations in clinical practice. Previous studies show that morally difficult challenges are related to decisions on treatment limitations, infringing on the child's integrity and growing autonomy, and interprofessional conflicts. Research also shows that healthcare professionals want ethics support to help them deal with morally difficult situations.Ethics case reflection (ECR)roundsare one example of ethics support. However, there is little research intohealthcare professionals’ perceptions of important outcomes prior to participation in ethics case reflectionrounds in childhood cancer care. The aim was to explorehealthcare professionals’ perceptions of outcomes of ECR rounds important for handling moral challenges prior to participation in ECR rounds in childhood cancer care.METHODS: This study is based on qualitative data. Healthcare professionals, mostly representing registered nurses, nursing assistants and physicians,working at childhood cancer care centres in Sweden, were invited to respond to the translated and content-validated European Moral Case Deliberation questionnaire,before participating in regular ECR rounds. The main open-ended question included in the questionnaire was analysed according to systematic text condensation. RESULTS: Data was collected from 161 responses from the healthcare professionals who were invited to participate. The responses included healthcare professionals’ perceptions of which ethics case reflection round-related outcomes they found important for handling moral challenges. Three different themes of important outcomes emerged from the analysis of the data: Inter-professional wellbeing, Being in a professional comfort zone, and Improved quality of care. The themes are related to teams, individuals and care, respectively.CONCLUSIONS: Healthcare professionals in childhood cancer care considered it important that ethics support could enhance the well-being of interprofessional teams, support healthcare professionals on an individual level and improve quality of care. To realize these perceived important outcomes, conditions for ECR rounds need to be improved. The results of this study can be used in future training for facilitators of ECR rounds, as well as providing information to healthcare managers wishing to implement this kind of ethics support.

scholarly journals Perceptions of important outcomes of moral case deliberations: a qualitative study among healthcare professionals in childhood cancer care

2020 ◽  
Author(s):  
Charlotte Weiner ◽  
Pernilla Pergert ◽  
Bert Molewijk ◽  
Anders Castor ◽  
Cecilia Bartholdson
Keyword(s):  
Quality Of Care ◽  
Childhood Cancer ◽  
Cancer Care ◽  
Healthcare Professionals ◽  
Well Being ◽  
Moral Case Deliberation ◽  
Individual Level ◽  
Ethics Support ◽  
Moral Case

Abstract BACKGROUND: In childhood cancer care, healthcare professionals must deal with several difficult moral situations in clinical practice. Previous studies show that morally difficult challenges are related to decisions on treatment limitations, infringing on the child's integrity and growing autonomy, and interprofessional conflicts. Research also shows that healthcare professionals have expressed a need for ethics support to help them deal with morally difficult situations. Moral case deliberations (MCDs) are one example of ethics support. The aim of this study was to describe the MCD-related outcomes that HCPs in childhood cancer care considered important, before MCDs were implemented, in order to facilitate the implementation of MCDs in childhood cancer care in Sweden.METHODS: This study is based on qualitative data. Healthcare professionals, mostly representing registered nurses, nursing assistants and physicians, working at childhood cancer care centres in Sweden, were invited to respond to the translated and content-validated European Moral Case Deliberation Outcomes Instrument, before participating in regular MCDs. The main open-ended question included in the questionnaire was analysed according to systematic text condensation. RESULTS: Data was collected from 161 responses from the healthcare professionals who were invited to participate. The responses included healthcare professionals’ perceptions of which MCD-related outcomes they found important for handling moral challenges. Three different themes of important outcomes from the analysis of the data are presented as follows: Interprofessional well-being in team interactions on a team level; Professional comfort when dealing with moral challenges on a personal level; and Improved quality of care on a care level. CONCLUSIONS: Healthcare professionals in childhood cancer care considered it important that ethics support could enhance the well-being of interprofessional teams, support healthcare professionals on an individual level and improve quality of care. The results of this study can be used in current and future training for MCD-facilitators. When knowing the context specific important MCD-outcomes, the sessions could be adapted. Managers in childhood cancer care would benefit from knowing about the specific important outcomes for their target group because they could then tailor the conditions.

scholarly journals Perceptions of important outcomes of moral case deliberations: a qualitative study among healthcare professionals in childhood cancer care

2020 ◽  
Author(s):  
Charlotte Weiner ◽  
Pernilla Pergert ◽  
Bert Molewijk ◽  
Anders Castor ◽  
Cecilia Bartholdson
Keyword(s):  
Quality Of Care ◽  
Childhood Cancer ◽  
Cancer Care ◽  
Healthcare Professionals ◽  
Well Being ◽  
Moral Case Deliberation ◽  
Individual Level ◽  
Ethics Support ◽  
Moral Case

Abstract BACKGROUND: In childhood cancer care, healthcare professionals must deal with several difficult moral situations in clinical practice. Previous studies show that morally difficult challenges are related to decisions on treatment limitations, infringing on the child's integrity and growing autonomy, and interprofessional conflicts. Research also shows that healthcare professionals want ethics support to help them deal with morally difficult situations. Moral case deliberations (MCDs) are one example of ethics support. The aim of this study was to describe MCD related outcomes that HCPs in childhood cancer care considered important to achieve, before MCDs were implemented, in order to support them in handling moral challenges in every day clinical practice.METHODS: This study is based on qualitative data. Healthcare professionals, mostly representing registered nurses, nursing assistants and physicians, working at childhood cancer care centres in Sweden, were invited to respond to the translated and content-validated European Moral Case Deliberation questionnaire, before participating in regular MCDs. The main open-ended question included in the questionnaire was analysed according to systematic text condensation. RESULTS: Data was collected from 161 responses from the healthcare professionals who were invited to participate. The responses included healthcare professionals’ perceptions of which MCD-related outcomes they found important for handling moral challenges. Three different themes of important outcomes from the analysis of the data are presented as follows: Inter-professional wellbeing, Being in a professional comfort zone, and Improved quality of care. The themes are related to teams, individuals and care, respectively.CONCLUSIONS: Healthcare professionals in childhood cancer care considered it important that ethics support could enhance the well-being of interprofessional teams, support healthcare professionals on an individual level and improve quality of care. The results of this study can be used for information in future training for MCD-facilitators. When knowing the context specific important MCD-outcomes, the sessions could be adapted. Managers in childhood cancer care would benefit from knowing about the specific important outcomes for their target group because they could then tailor the conditions. Finally, this study contributes to the reflection upon and evaluation of appropriate CESS outcomes in general.

Moral case deliberation

2017 ◽  
Vol 18 (3) ◽  
pp. 181-186 ◽  
Author(s):  
Daniel Y B Tan ◽  
Bastiaan C ter Meulen ◽  
Albert Molewijk ◽  
Guy Widdershoven
Keyword(s):  
Support Services ◽  
Healthcare Professionals ◽  
Ethical Dilemmas ◽  
Daily Practice ◽  
Moral Case Deliberation ◽  
Ethics Support ◽  
Moral Case ◽  
Moral Damage ◽  
Dilemma Method

Ethical dilemmas in general are characterised by a choice between two mutually excluding options neither of which is satisfactory, because there always will be a form of moral damage. Within the context of medicine several ethics support services have been developed to support healthcare professionals in dealing with ethical dilemmas, including moral case deliberation. In this article, we describe how moral case deliberation works in daily practice, illustrated with a case example from the neurology ward. The article is meant as an introduction to moral case deliberation according to the dilemma method. We show its relevance to the clinic and the context needed to put it into practice.

scholarly journals Outcomes of Moral Case Deliberation - the development of an evaluation instrument for clinical ethics support (the Euro-MCD)

2014 ◽  
Vol 15 (1) ◽  
Author(s):  
Mia Svantesson ◽  
Jan Karlsson ◽  
Pierre Boitte ◽  
Jan Schildman ◽  
Linda Dauwerse ◽  
...  
Keyword(s):  
Clinical Ethics ◽  
Moral Case Deliberation ◽  
Evaluation Instrument ◽  
Clinical Ethics Support ◽  
Ethics Support ◽  
Moral Case

scholarly journals Dealing with Moral Challenges in Treatment of Transgender Children and Adolescents: Evaluating the Role of Moral Case Deliberation

2020 ◽  
Vol 49 (7) ◽  
pp. 2619-2634 ◽  
Author(s):  
Lieke Josephina Jeanne Johanna Vrouenraets ◽  
Laura A. Hartman ◽  
Irma M. Hein ◽  
Annelou L. C. de Vries ◽  
Martine C. de Vries ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Evaluation Study ◽  
Future Research ◽  
Moral Case Deliberation ◽  
Moral Inquiry ◽  
Care Providers ◽  
Open Communication ◽  
Daily Work ◽  
Moral Case

Abstract Treatment teams providing affirmative medical transgender care to young people frequently face moral challenges arising from the care they provide. An adolescent’s capacity to consent, for example, could raise several issues and challenges. To deal with these challenges more effectively, several Dutch treatment teams started using a relatively well-established form of clinical ethics support (CES) called Moral Case Deliberation (MCD). MCD is a facilitator-led, collective moral inquiry based on a real case. This study’s purpose is to describe the teams’ perceived value and effectiveness of MCD. We conducted a mixed methods evaluation study using MCD session reports, individual interviews, focus groups, and MCD evaluation questionnaires. Our results show that Dutch transgender care providers rated MCD as highly valuable in situations where participants were confronted with moral challenges. The health care providers reported that MCD increased mutual understanding and open communication among team members and strengthened their ability to make decisions and take action when managing ethically difficult circumstances. However, the health care providers also expressed criticisms of MCD: some felt that the amount of time spent discussing individual cases was excessive, that MCD should lead to more practical and concrete results, and that MCD needed better integration and follow-up in the regular work process. We recommend future research on three matters: studying how MCD contributes to the quality of care, involvement of transgender people themselves in MCD, and integration of CES into daily work processes.

Moral Competence, Moral Teamwork, Moral Action – Outcomes of Moral Case Deliberation in the Euro-MCD 2.0 For Evaluating Clinical Ethics Support

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 67-67
Author(s):  
Janine de Snoo-Trimp ◽  
◽  
Keyword(s):  
Clinical Ethics ◽  
Healthcare Professionals ◽  
Moral Action ◽  
Moral Case Deliberation ◽  
Moral Competence ◽  
Revision Process ◽  
Clinical Ethics Support ◽  
Ethics Support ◽  
Moral Case ◽  
Difficult Situations

"Background: For Moral Case Deliberation (MCD), like any form of Clinical ethics support (CES), it is important to know whether it reaches its presumed goal of supporting healthcare professionals in their ethical challenges. Evaluation is needed to gain insight in the value of MCD. Therefore, the Euro-MCD instrument was developed to assess outcomes of MCD, and has now been revised. The aim of this presentation is to present the revised Instrument: the Euro-MCD 2.0. Methods: The revision process was an iterative dialogue in which field study findings were integrated with theoretical reflections and expert-input. Results: The Euro-MCD 2.0 has three domains: 1) Moral Competence, 2) Moral Teamwork and 3) Moral Action. Moral Competence includes items on moral sensitivity, analytical skills and a virtuous attitude, like ‘I speak up in ethically difficult situations’. Moral Teamwork refers to open dialogue and supportive relationships, for example ‘We feel secure to share emotions in ethically difficult situations’. Moral Action includes items about moral decision-making and responsible care, like ‘We are able to explain and justify our care towards patients and their families’. Discussion: The Euro-MCD 2.0 is shorter and more strongly substantiated by empirical data and theoretical reflections. At the conference, we will reflect on the revision process and the underlying foundations of the domains. The revised instrument helps to get insight in the MCD related outcomes for healthcare professionals in their daily practice. Our research can further improve implementation of MCD and contribute to the research field of evaluation of CES in general. "

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