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Table 2 Final clusters of MCD outcomes, including items and comparison with Euro-MCD items and domains

From: Defining and categorizing outcomes of Moral Case Deliberation (MCD): concept mapping with experienced MCD participants

Clusters # Items
*Original items from Euro-MCD Instrument
Comparable to which Euro-MCD item according to research team; empty = no comparable item found
(for all items except the 11 Euro-MCD items that were explicitly added in the focus group)
From which Euro-MCD Domain
1. Organisation and Policy
(A in Fig. 3)
4 Support to proceed in a particular direction Enables to decide on concrete actions Concrete Results
26 Identify relevant themes Identify core ethical question Moral Reflexivity
31 Clarify what good care entails -  
35 Contribute to organisational change or cultural shift Contribute to development of practice/policies Organisational Level
38 Support in the development of new products and services Contribute to development of practice/policies Organisational Level
40 Less absence due to sickness -  
46 Prevention of similar case/event in the future Become aware of recurring ethical situations Organisational Level
47 Anticipate, show restraint in similar case/event Become aware of recurring ethical situations Organisational Level
48 Initiate formulation of policy Contribute to development of practice/policies Organisational Level
82 Better quality of work -  
2. Team development
(B. in Fig. 3)
5 Accepting an outcome -  
7 Unity in teams/increased mutual cohesion -  
8 Team spirit/sense of belonging to group -  
9 Difficult themes can become subject of discussion -  
44 Team continues with method of examination as in MCD -  
45 Team jointly determines team values -  
55 Less hierarchical interaction -  
56 Gentler communication -  
60 Get to know each other better Better mutual understanding Enhanced Collaboration
61 Enhance professional identity Better understanding of being good professional Moral Attitude
63 Commitment to the organisation -  
64 Help each other more readily -  
68 More open communication* Not applicable – original Euro-MCD item Enhanced Collaboration
70 Greater opportunity for everyone to have their say* Not applicable – original Euro-MCD item Enhanced Collaboration
71 Share difficult emotions and thoughts* Not applicable – original Euro-MCD item Emotional Support
78 Mutual respect* Not applicable – original Euro-MCD item Enhanced Collaboration
3. Personal development focused on the other person
(C and D in Fig. 3)
6 Curiosity about the other person -  
20 More sensitive to the perspective of another person See the situation from different perspectives Moral Reflexivity
21 Accepting other person’s perspective -  
22 Appreciate other person’s perspective -  
72 I listen more seriously to others’ opinions* Not applicable – original Euro-MCD item Moral Attitude
76 Manage disagreements more constructively* Not applicable – original Euro-MCD item Enhanced Collaboration
4. Personal development as a professional, focused on Skills
(E in Fig. 3)
14 Learn what the relevant norms and values are -  
15 Knowledge of ethical concepts Enhanced understanding of ethical theories Moral Reflexivity
17 Understanding which values and norms are in conflict with each other -  
19 Understanding of diversity of norms and values, interpersonal -  
24 Postpone personal judgments about situations -  
27 Identify recurring norms and values in particular themes Identify core ethical question Moral Reflexivity
28 Identify how moral issues are dealt with -  
30 Tools to reflect on moral dilemmas Skills to analyze Moral Reflexivity
41 Clarity about what the issue is and what is at stake Identify core ethical question Moral Reflexivity
42 More awareness of unequal balance of power -  
5. Personal development as a professional, focused on Knowledge
(F in Fig. 3)
12 Dilemma awareness, increased moral sensitivity Identify core ethical question Moral Reflexivity
23 Postpone personal judgments about individuals More awareness of preconceived notions Moral Attitude
29 Reflexive skills Skills to analyze Moral Reflexivity
34 Master at asking questions -  
69 Increased awareness of complexity of situation* Not applicable – original Euro-MCD item Moral Reflexivity
75 Examine practice/policies critically* Not applicable – original Euro-MCD item Organisational Level
79 Change your mind -  
81 Take a step back to look at problem from a distance -  
85 Understanding of role-related quality of norms and values -  
6. Personal development as an individual
(G in Fig. 3)
13 More awareness of personal judgment More awareness of preconceived notions Moral Attitude
25 Examine personal judgment -  
36 Reduce blind spots -  
37 Increase awareness of your blind spots -  
58 Creative thinking -  
73 Increased awareness of own emotions* Not applicable – original Euro-MCD item Emotional Support
77 Gain more clarity about own responsibility* Not applicable – original Euro-MCD item Moral Attitude
84 Become more honest -  
7. Perception and Connection
(H in Fig. 3)
1 Substantiate decision made by staff member Consensus in how to manage the situation Concrete Results
2 Feel you do not have to deal with the problem alone -  
3 Support -  
33 Relieves stress for case presenter Better manage stress from the situation Emotional support
39 Delight in astonishment about differences -  
43 Person presenting the case feels s/he is heard -  
49 Disappointment about outcome -  
50 Sense of wasting time -  
52 Recognition brings sense of relief -  
53 Sense of relief -  
54 Fewer psychological complaints -  
59 Enjoy your work more -  
62 Increased motivation regarding work -  
65 Feel enriched by unexpected new insights -  
66 You feel taken care of, nurturing for your inner self -  
67 Be able to move on -  
74 Strengthened self-confidence* Not applicable – original Euro-MCD item Emotional Support
80 Confirmation of having made the right decision -  
83 To feel safe Feel more secure to express doubts/Courage to express doubts or uncertainty Emotional Support/Moral Attitude
8. Concrete action
(I and J in Fig. 3)
10 A concrete plan of action, a or b Enables to decide on concrete actions Concrete Results
11 Plan of action on how to deal with damage -  
32 Look for the answer for the client/central person in the case -  
51 More awareness how personal values influence working together -  
57 Increase range of action Find more courses of action Concrete Results
  1. #The numbers of the items correspond to the numbering in Fig. 2
  2. *Original items from Euro-MCD Instrument