163 Dealing with moral challenges in treatment for transgender children and adolescents: evaluating the role of moral case deliberation 9 from 50 to 116 minutes and were audiotaped. We transcribed verbatim four MCD sessions. The MCD facilitators wrote a summary of all six MCD sessions and sent this back to the MCD participants to verify its accuracy. Moral case deliberation evaluation in individual interviews We conducted semi-structured individual interviews with six members of both the Amsterdam and Leiden transgender teams in February 2015. We formulated our initial interview topics after reviewing the relevant literature and then examining how the teams had experienced the MCD sessions (Janssens et al., 2014). The interviews contained general topics and no closed-ended questions. In the interviews, we asked the participants to elaborate on their personal experiences with MCD and the method’s effects, or lack thereof, at the patient level or protocol level. One of the researchers conducted the interviews, and a participating intern took notes during the four interviews. The interviews lasted from 60 to 90 minutes and were audiotaped and transcribed verbatim. A summary of each individual interview was sent to the participant to verify its accuracy. Evaluation of moral case deliberation by focus groups We conducted two focus groups in March 2015. During these focus groups, we presented several anonymous quotes from the individual interviews to trigger the conversation. We asked the group participants whether they could identify and/or agree with the quotes and invited the participants to express any other views they held on the use of MCD. Our goal was to establish a dialogue among the team members rather than maintaining a strict question-and-answer format. Two of the researchers facilitated each focus group. During one focus group, a second researcher made observatory notes, while in the other focus group the observatory notes were taken by a participating intern. The focus groups lasted from 100 to 120 minutes and were audiotaped and transcribed verbatim. A summary of each focus group discussion was sent to the transgender team to verify their accuracy. Moral case deliberation evaluation by means of the Euro-MCD questionnaire The Euro-MCD questionnaire is a qualitatively validated questionnaire (Svantesson et al., 2014). This instrument was developed to measure: (1) the perceived importance of MCD outcomes prior to MCD sessions (T0); (2) the experienced MCD outcomes during the MCD sessions (T1); and (3) the experienced MCD outcomes within daily work after a series of two to four MCD sessions (T1). The 26 outcomes cover six domains: enhanced emotional support; enhanced collaboration; improved moral reflexivity; improved moral attitude; improvement at organizational level; concrete results concerning the care or treatment
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