TY - JOUR
T1 - Two years of ethics reflection groups about coercion in psychiatry. Measuring variation within employees’ normative attitudes, user involvement and the handling of disagreement
AU - Molewijk, Bert
AU - Pedersen, Reidar
AU - Kok, Almar
AU - Førde, Reidun
AU - Aasland, Olaf
N1 - Funding Information: Open access funding provided by University of Oslo (incl Oslo University Hospital). We received funding from the Norwegian Directorate of Health (2011–2016). The Directorate played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. Funding Information: We are grateful to all the employees of the seven departments who were willing to fill in the survey at T0, T1 and/or T2. We are also grateful for the long-time cooperation with the involved mental health care institutions, the local coordinators of the PET study at the seven departments and the trained facilitators of the Ethics Reflection Groups. We also want to thank our colleagues of the Centre for Medical Ethics at the University of Oslo for our multidisciplinary cooperation within the project “Psychiatry, Ethics and Coercion” as well as the members of the Sounding Board of this research project for their valuable input and support. Finally, we would like to thank Irene Syse and Kristin Weaver for (coordinating the) inserting and checking of the statistical data. Publisher Copyright: © 2023, The Author(s).
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Background: Research on the impact of ethics reflection groups (ERG) (also called moral case deliberations (MCD)) is complex and scarce. Within a larger study, two years of ERG sessions have been used as an intervention to stimulate ethical reflection about the use of coercive measures. We studied changes in: employees’ attitudes regarding the use of coercion, team competence, user involvement, team cooperation and the handling of disagreement in teams. Methods: We used panel data in a longitudinal design study to measure variation in survey scores from multidisciplinary employees from seven departments within three Norwegian mental health care institutions at three time points (T0–T1–T2). Mixed models were used to account for dependence of data in persons who participated more than once. Results: In total, 1068 surveys (from 817 employees who did and did not participate in ERG) were included in the analyses. Of these, 7.6% (N = 62) responded at three points in time, 15.5% (N = 127) at two points, and 76.8% (N = 628) once. On average, over time, respondents who participated in ERG viewed coercion more strongly as offending (p < 0.05). Those who presented a case in the ERG sessions showed lower scores on User Involvement (p < 0.001), Team Cooperation (p < 0.01) and Constructive Disagreement (p < 0.01). We observed significant differences in outcomes between individuals from different departments, as well as between different professions. Initial significant changes due to frequency of participation in ERG and case presentation in ERG did not remain statistically significant after adjustment for Departments and Professions. Differences were generally small in absolute terms, possibly due to the low amount of longitudinal data. Conclusions: This study measured specific intervention-related outcome parameters for describing the impact of clinical ethics support (CES). Structural implementation of ERGs or MCDs seems to contribute to employees reporting a more critical attitude towards coercion. Ethics support is a complex intervention and studying changes over time is complex in itself. Several recommendations for strengthening the outcomes of future CES evaluation studies are discussed. CES evaluation studies are important, since—despite the intrinsic value of participating in ERG or MCD—CES inherently aims, and should aim, at improving clinical practices.
AB - Background: Research on the impact of ethics reflection groups (ERG) (also called moral case deliberations (MCD)) is complex and scarce. Within a larger study, two years of ERG sessions have been used as an intervention to stimulate ethical reflection about the use of coercive measures. We studied changes in: employees’ attitudes regarding the use of coercion, team competence, user involvement, team cooperation and the handling of disagreement in teams. Methods: We used panel data in a longitudinal design study to measure variation in survey scores from multidisciplinary employees from seven departments within three Norwegian mental health care institutions at three time points (T0–T1–T2). Mixed models were used to account for dependence of data in persons who participated more than once. Results: In total, 1068 surveys (from 817 employees who did and did not participate in ERG) were included in the analyses. Of these, 7.6% (N = 62) responded at three points in time, 15.5% (N = 127) at two points, and 76.8% (N = 628) once. On average, over time, respondents who participated in ERG viewed coercion more strongly as offending (p < 0.05). Those who presented a case in the ERG sessions showed lower scores on User Involvement (p < 0.001), Team Cooperation (p < 0.01) and Constructive Disagreement (p < 0.01). We observed significant differences in outcomes between individuals from different departments, as well as between different professions. Initial significant changes due to frequency of participation in ERG and case presentation in ERG did not remain statistically significant after adjustment for Departments and Professions. Differences were generally small in absolute terms, possibly due to the low amount of longitudinal data. Conclusions: This study measured specific intervention-related outcome parameters for describing the impact of clinical ethics support (CES). Structural implementation of ERGs or MCDs seems to contribute to employees reporting a more critical attitude towards coercion. Ethics support is a complex intervention and studying changes over time is complex in itself. Several recommendations for strengthening the outcomes of future CES evaluation studies are discussed. CES evaluation studies are important, since—despite the intrinsic value of participating in ERG or MCD—CES inherently aims, and should aim, at improving clinical practices.
KW - Attitudes
KW - Clinical ethics support
KW - Coercion
KW - Constructive disagreement
KW - Ethics reflection groups
KW - Mental health care
KW - Moral case deliberation
KW - Outcomes evaluation
KW - Repeated cross-sectional survey
KW - User involvement
UR - http://www.scopus.com/inward/record.url?scp=85159221490&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s12910-023-00909-w
DO - https://doi.org/10.1186/s12910-023-00909-w
M3 - Article
C2 - 37173770
SN - 1472-6939
VL - 24
JO - BMC medical ethics
JF - BMC medical ethics
IS - 1
M1 - 29
ER -