• Niek Kok, Marieke Zegers, Steven Teerenstra, Malaika Fuchs, Johannes G van der Hoeven, Jelle L P van Gurp, and HoedemaekersCornelia W ECWEDepartment Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands..
• Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
• Crit. Care Med. 2023 Oct 1; 51 (10): 129413051294-1305.

ObjectivesMoral case deliberation (MCD) is a team-based and facilitator-led, structured moral dialogue about ethical difficulties encountered in practice. This study assessed whether offering structural MCD in ICUs reduces burnout symptoms and moral distress and strengthens the team climate among ICU professionals.DesignThis is a parallel cluster randomized trial.SettingSix ICUs in two hospitals located in Nijmegen, between January 2020 and September 2021.SubjectsFour hundred thirty-five ICU professionals.InterventionsThree of the ICUs organized structural MCD. In three other units, there was no structural MCD or other structural discussions of moral problems.Measurements And Main ResultsThe primary outcomes investigated were the three burnout symptoms-emotional exhaustion, depersonalization, and a low sense of personal accomplishment-among ICU professionals measured using the Maslach Burnout Inventory on a 0-6 scale. Secondary outcomes were moral distress (Moral Distress Scale) on a 0-336 scale and team climate (Safety Attitude Questionnaire) on a 0-4 scale. Organizational culture was an explorative outcome (culture of care barometer) and was measured on a 0-4 scale. Outcomes were measured at baseline and in 6-, 12-, and 21-month follow-ups. Intention-to-treat analyses were conducted using linear mixed models for longitudinal nested data. Structural MCD did not affect emotional exhaustion or depersonalization, or the team climate. It reduced professionals' personal accomplishment (-0.15; p < 0.05) but also reduced moral distress (-5.48; p < 0.01). Perceptions of organizational support (0.15; p < 0.01), leadership (0.19; p < 0.001), and participation opportunities (0.13; p < 0.05) improved.ConclusionsAlthough structural MCD did not mitigate emotional exhaustion or depersonalization, and reduced personal accomplishment in ICU professionals, it did reduce moral distress. Moreover, it did not improve team climate, but improved the organizational culture.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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