RT Journal Article
SR Electronic
T1 Ethical decision-making climate in the ICU: theoretical framework and validation of a self-assessment tool
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 781
OP 789
DO 10.1136/bmjqs-2017-007390
VO 27
IS 10
A1 Bo Van den Bulcke
A1 Ruth Piers
A1 Hanne Irene Jensen
A1 Johan Malmgren
A1 Victoria Metaxa
A1 Anna K Reyners
A1 Michael Darmon
A1 Katerina Rusinova
A1 Daniel Talmor
A1 Anne-Pascale Meert
A1 Laura Cancelliere
A1 Làszló Zubek
A1 Paolo Maia
A1 Andrej Michalsen
A1 Johan Decruyenaere
A1 Erwin J O Kompanje
A1 Elie Azoulay
A1 Reitske Meganck
A1 Ariëlla Van de Sompel
A1 Stijn Vansteelandt
A1 Peter Vlerick
A1 Stijn Vanheule
A1 Dominique D Benoit
YR 2018
UL http://qualitysafety.bmj.com/content/27/10/781.abstract
AB Background Literature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU).Objectives To better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates.Methods 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.Results 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.Conclusions 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.