Does facilitation improve moral case deliberation quality?

Abstract

BackgroundMoral Case Deliberation (MCD) is a standardized method to support healthcare professionals in reflecting upon and making morally challenging decisions guided by a trained facilitator.Research questionsThe study addresses the following research questions: (1) (How) does the addition of a trained MCD facilitator applying the stepwise plan of Bauduin and Kanne improve the quality of deliberation compared to regular case/team discussions/meetings? (2) (How) does the quality of the deliberation within the MCD intervention group improve differently over time compared to regular case/team discussions/meetings?Participants and research contextThree treatment teams of wards in a maximum secured forensic psychiatric hospital in the north of the Netherlands participated in this study.Research designA control group deliberated six times about moral decisions as usual. Two other teams deliberated two times "as usual" and four times led by a trained facilitator. All deliberation sessions were video recorded. These videos were assessed on four factors by 54 applied university students: variety of argumentation, critical engagement, moral focus, and structure of deliberation.Ethical considerationsWritten informed consent was obtained from all team members for the use of video recordings. In addition, a confidentiality statement was provided to all student assessors.ResultsThis study indicates that adding a trained MCD facilitator using a step-by-step plan improves the quality of deliberation within MCD compared to regular case/team discussions/meetings. A facilitator has shown a positive impact by enhancing the four factors of quality of deliberation within MCD. Also, the quality within both MCD intervention groups improved differently over time.ConclusionsThis first step on how to conceptualize and measure quality of moral deliberations via video analysis will be useful for future ethics support and ethics education studies.