TY  - JOUR
T1  - Impact of Ethical Communication Interventions on Healthcare Practice: Evidence from a Cluster Randomized Controlled Trial
A1  - Grace Y. Tan
A1  - Daniel Ho
A1  - Rachel Koh
JF  - Asian Journal of Ethics in Health and Medicine
JO  - Asian J Ethics Health Med
SN  - 3108-5059
Y1  - 2022
VL  - 2
IS  - 1
DO  - 10.51847/cyCyFcsNMP
SP  - 127
EP  - 138
N2  - Studies show that healthcare workers often encounter complex ethical dilemmas in their everyday practice, underscoring the need for organized interprofessional dialogue. Ethics communication in groups (ECG), which is based on Jürgen Habermas’s theory of communicative action, offers a structured approach to foster joint reflection on moral concerns. The “one to five method” is a hands-on technique designed for clinicians who have received ethics training, allowing them to lead ECG sessions seamlessly within regular clinical workflows. The aim is to assess how structured ethics communication in groups (ECG), utilizing the ‘one to five’ method, impacts healthcare professionals’ experiences of moral distress and perceptions of the ethical climate in 24-hour care wards, compared to a control group. The study was a forward-looking, cluster-randomized trial conducted with an open-label, non-blinded design. Nine departments representing various medical specialties within a single university hospital were deliberately selected and subsequently randomized into an intervention arm (five wards) and a control arm (four wards). In the intervention arm, structured Group-based Ethics Communication (ECG) sessions using the ‘one to five’ method were conducted once a month over a six-month period. Outcome measurements were collected prospectively at three months and six months post-baseline with the Measure of Moral Distress for Healthcare Professionals (MMD-HP), the Moral Distress Thermometer (MDT), and the Swedish version of the Ethical Climate Questionnaire (SwECQ).Between-group comparisons revealed no statistically significant differences in overall moral distress across the study period. However, within-group analysis indicated that, at the 3-month follow-up, the intervention group reported significantly lower moral distress related to patient-level clinical situations compared to baseline, although this reduction was not sustained and returned to control-group levels by the 6-month assessment. In contrast, perceived ethical climate was consistently rated higher in the intervention group at both the 3-month and 6-month follow-up points. Engaging in ethics communication in groups (ECG) appears to promote common values and improve the ethical climate, even though it did not lead to significant changes in levels of moral distress. Moral distress may continue despite such interventions, but opportunities for open discussion and professional development can help build moral resilience. The study demonstrated a positive association between participation in ECG using the ‘one to five method’ and a supportive ethical climate. However, the small number of participants limited the ability to detect statistically significant effects. Future studies should involve larger, multicenter samples and incorporate qualitative approaches to better understand experiences with ECG.
UR  - https://smerpub.com/article/impact-of-ethical-communication-interventions-on-healthcare-practice-evidence-from-a-cluster-random-t3cwisdmbjmzyvy
ER  -