Development and Validation of a Case-Based Survey Assessing Ethical Decision-Making in Prehospital Resuscitation

OBJECTIVES: Ethical considerations are central to deciding on resuscitation in a prehospital setting. A systematic study of ethical views can enlighten the area and potentially reveal variations in decision-making. We aimed to explore the ethical views on resuscitation and their impact on the reasoning of prehospital healthcare professionals using a qualitative approach and a structured questionnaire. This study describes the validation of a structured questionnaire designed to explore the ethical views on resuscitation and its impact on the reasoning of prehospital healthcare professionals.

METHODS: This observational cross-sectional study used a mixed-methods approach. The questionnaire included qualitative free-text fields and quantitative scales. Its first version was developed based on data from a systematic review and an ethnographic study. Validation involved face-to-face interviews and a two-round Delphi process with experts in qualitative research, philosophy, epidemiology, and prehospital medicine. The final questionnaire was field-tested among Danish prehospital physicians. Exploratory factor analysis assessed underlying relationships, and Cronbach's alpha measured internal consistency.

RESULTS: 216 out of 380 invited Danish prehospital physicians completed the questionnaire. The ethical aspects addressed in the cases included "do-not-attempt cardiopulmonary resuscitation," "socioeconomic status," "quality of life," "the patient and family's cultural background," and "relatives' emotional reaction." The questionnaire demonstrated satisfactory internal consistency, with a Cronbach's alpha of 0.71.

CONCLUSIONS: The questionnaire was validated as a tool for assessing moral reasoning and variations in perspectives in prehospital decision-making. The survey can be used to assess the moral reasoning and variations therein in prehospital resuscitation decision-making.