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

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.

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.

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.

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.