Proefschrift

164 Chapter 9 (see Appendix D, which can be found at page 225, for an example). Participants were asked at T0 how important they found these 26 outcomes (on a 4-point Likert scale: very important; important; somewhat important; not important); and at T1 whether they experienced these outcomes (on a 4-point Likert scale: experienced to a great extent; experienced to a reasonable extent; experienced to some extent; did not experience). The Euro-MCD questionnaire also contains some open-ended questions asking, for instance, what outcome the respondent expected (without reading the 26 outcomes) and how the respondent prioritized the five most important outcomes. Finally, the Euro-MCD questionnaire also collects some of the participants’ general characteristics (e.g., age, sex, specialty, institution). We obtained these empirical data between April 2014 and October 2014, during two joint meetings of the Amsterdam and Leiden teams. Data analysis Moral case deliberation sessions, individual interviews, and focus groups Following an initial open reading of the qualitative data, the authors independently identified some preliminary sub-themes. Then, through a deliberative process, the authors redefined the initial sub-themes into main themes until they reached a consensus. This hermeneutic analysis (Miles & Huberman, 1994; Stake, 2005), partly inspired by the interview guide, resulted in four main themes: (1) Positive experiences with MCD; (2) Critical remarks about MCD; (3) Changes in daily work processes after MCD; (4) Recommendations for the future use of MCD or MCD elements in daily work processes. Two authors conducted an additional round of analyses to assess whether the themes or sub-themes enabled them to accurately subdivide the outcome of qualitative data. Following this assessment, they kept the four initially defined main themes unchanged. We then re-analysed the transcripts of the MCD sessions, the focus groups, and the individual interviews and selected representative quotations for each of the defined themes, taking equal care to draw quotations from all data sources. Integration of moral case deliberation sessions, individual interviews, focus groups, and Euro-MCD questionnaires In the present study, the results obtained from each of the four methods to produce four sets of findings were collected and analysed separately. Subsequently, these data were combined in a process called ‘triangulation’ (O’Cathain et al., 2010). Combining the data of all four methods consisted of comparing the qualitative and quantitative data and reflecting upon the similarities and differences found.

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