Bo Van den Bulcke
Ghent University Hospital, Belgium
Title: Ethical decision-making climate in the ICU: Theoretical framework and validation of a self-assessment tool
Biography
Biography: Bo Van den Bulcke
Abstract
Context: Literature depicts differences in ethical decision making (EDM) between countries and intensive care units.
Objectives: To better conceptualize 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 EDM climate questionnaire (EDMCQ) was developed to capture three EDM domains in health care:
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 United States. Exploratory
and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians.
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 decisionmaking,
active decision-making by physicians, practice and culture of ethical awareness.
Conclusions: The 32-item version of the EDMCQ might enrich the ethical decision-making climate measurement, clinicians’
behaviour and the performance of health care organizations. This instrument offers opportunities to develop tailored ICU team
interventions.