Ethical decision-making climate in the ICU: theoretical framework and validation of a self-assessment tool.
Identifieur interne : 000952 ( Main/Exploration ); précédent : 000951; suivant : 000953Ethical decision-making climate in the ICU: theoretical framework and validation of a self-assessment tool.
Auteurs : Bo Van Den Bulcke [Belgique] ; Ruth Piers [Belgique] ; Hanne Irene Jensen [Danemark] ; Johan Malmgren [Suède] ; Victoria Metaxa [Royaume-Uni] ; Anna K. Reyners [Pays-Bas] ; Michael Darmon [France] ; Katerina Rusinova [République tchèque] ; Daniel Talmor [États-Unis] ; Anne-Pascale Meert [Belgique] ; Laura Cancelliere [Italie] ; Làszl Zubek [Hongrie] ; Paolo Maia [Portugal] ; Andrej Michalsen [Allemagne] ; Johan Decruyenaere [Belgique] ; Erwin J O. Kompanje [Pays-Bas] ; Elie Azoulay [France] ; Reitske Meganck [Belgique] ; Ariëlla Van De Sompel [Belgique] ; Stijn Vansteelandt [Belgique] ; Peter Vlerick [Belgique] ; Stijn Vanheule [Belgique] ; Dominique D. Benoit [Belgique]Source :
- BMJ quality & safety [ 2044-5423 ] ; 2018.
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Abstract
BACKGROUND
Literature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU).
OBJECTIVES
To better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates.
METHODS
Using a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment. This instrument was subsequently validated among clinicians working in 68 adult ICUs in 13 European countries and the USA. Exploratory and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians. Measurement invariance was tested to make sure that variables used in the analysis were comparable constructs across different groups.
RESULTS
Of 3610 nurses and 1137 physicians providing ICU bedside care, 2275 (63.1%) and 717 (62.9%) participated respectively. Statistical analyses revealed that a shortened 32-item version of the EDMCQ scale provides a factorial valid measurement of seven facets of the extent to which clinicians perceive an EDM climate: self-reflective and empowering leadership by physicians; practice and culture of open interdisciplinary reflection; culture of not avoiding end-of-life decisions; culture of mutual respect within the interdisciplinary team; active involvement of nurses in end-of-life care and decision-making; active decision-making by physicians; and practice and culture of ethical awareness. Measurement invariance of the EDMCQ across occupational groups was shown, reflecting that nurses and physicians interpret the EDMCQ items in a similar manner.
CONCLUSIONS
The 32-item version of the EDMCQ might enrich the EDM climate measurement, clinicians' behaviour and the performance of healthcare organisations. This instrument offers opportunities to develop tailored ICU team interventions.
DOI: 10.1136/bmjqs-2017-007390
PubMed: 29475979
Affiliations:
- Allemagne, Belgique, Danemark, France, Hongrie, Italie, Pays-Bas, Portugal, Royaume-Uni, République tchèque, Suède, États-Unis
- Angleterre, Auvergne-Rhône-Alpes, Bohême centrale, Grand Londres, Groningue (province), Hollande-Méridionale, Hongrie centrale, Massachusetts, Province de Flandre-Orientale, Rhône-Alpes, Région de Bruxelles-Capitale, Région flamande, Île-de-France
- Bruxelles, Budapest, Gand, Groningue, Londres, Paris, Prague, Rotterdam, Saint-Étienne
- Université de Gand, Université de Groningue
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centrale</region></placeName></affiliation></author><author><name sortKey="Talmor, Daniel" sort="Talmor, Daniel" uniqKey="Talmor D" first="Daniel" last="Talmor">Daniel Talmor</name><affiliation wicri:level="2"><nlm:affiliation>Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Meert, Anne Pascale" sort="Meert, Anne Pascale" uniqKey="Meert A" first="Anne-Pascale" last="Meert">Anne-Pascale Meert</name><affiliation wicri:level="3"><nlm:affiliation>Service des Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, ULB, Bruxelles, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Service des Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, ULB, Bruxelles</wicri:regionArea><placeName><settlement type="city">Bruxelles</settlement><region nuts="2">Région de Bruxelles-Capitale</region></placeName></affiliation></author><author><name sortKey="Cancelliere, Laura" sort="Cancelliere, Laura" uniqKey="Cancelliere L" first="Laura" last="Cancelliere">Laura Cancelliere</name><affiliation wicri:level="1"><nlm:affiliation>SCDU Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria, 'Maggiore della Carità', Novara, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>SCDU Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria, 'Maggiore della Carità', Novara</wicri:regionArea><wicri:noRegion>Novara</wicri:noRegion></affiliation></author><author><name sortKey="Zubek, Laszl" sort="Zubek, Laszl" uniqKey="Zubek L" first="Làszl" last="Zubek">Làszl Zubek</name><affiliation wicri:level="3"><nlm:affiliation>Department of Anesthesiology and Intensive Therapy, Semmelweis University Budapest, Budapest, Hungary.</nlm:affiliation><country xml:lang="fr">Hongrie</country><wicri:regionArea>Department of Anesthesiology and Intensive Therapy, Semmelweis University Budapest, Budapest</wicri:regionArea><placeName><settlement type="city">Budapest</settlement><region nuts="2">Hongrie centrale</region></placeName></affiliation></author><author><name sortKey="Maia, Paolo" sort="Maia, Paolo" uniqKey="Maia P" first="Paolo" last="Maia">Paolo Maia</name><affiliation wicri:level="1"><nlm:affiliation>Department of Intensive Care, Hospital de Santo António, Porto, Portugal.</nlm:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>Department of Intensive Care, Hospital de Santo António, Porto</wicri:regionArea><wicri:noRegion>Porto</wicri:noRegion></affiliation></author><author><name sortKey="Michalsen, Andrej" sort="Michalsen, Andrej" uniqKey="Michalsen A" first="Andrej" last="Michalsen">Andrej Michalsen</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesiology and Critical Care Medicine, Tettnang Hospital, Tettnang, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Anaesthesiology and Critical Care Medicine, Tettnang Hospital, Tettnang</wicri:regionArea><wicri:noRegion>Tettnang</wicri:noRegion><wicri:noRegion>Tettnang</wicri:noRegion><wicri:noRegion>Tettnang</wicri:noRegion></affiliation></author><author><name sortKey="Decruyenaere, Johan" sort="Decruyenaere, Johan" uniqKey="Decruyenaere J" first="Johan" last="Decruyenaere">Johan Decruyenaere</name><affiliation wicri:level="1"><nlm:affiliation>Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care Medicine, Ghent University Hospital, Ghent</wicri:regionArea><wicri:noRegion>Ghent</wicri:noRegion></affiliation></author><author><name sortKey="Kompanje, Erwin J O" sort="Kompanje, Erwin J O" uniqKey="Kompanje E" first="Erwin J O" last="Kompanje">Erwin J O. Kompanje</name><affiliation wicri:level="3"><nlm:affiliation>Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.</nlm:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, Rotterdam</wicri:regionArea><placeName><settlement type="city">Rotterdam</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Azoulay, Elie" sort="Azoulay, Elie" uniqKey="Azoulay E" first="Elie" last="Azoulay">Elie Azoulay</name><affiliation wicri:level="3"><nlm:affiliation>Medical Intensive Care Unit, Hôpital Saint-Louis and University Paris-7, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Medical Intensive Care Unit, Hôpital Saint-Louis and University Paris-7, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Meganck, Reitske" sort="Meganck, Reitske" uniqKey="Meganck R" first="Reitske" last="Meganck">Reitske Meganck</name><affiliation wicri:level="4"><nlm:affiliation>Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent</wicri:regionArea><orgName type="university">Université de Gand</orgName><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName></affiliation></author><author><name sortKey="Van De Sompel, Ariella" sort="Van De Sompel, Ariella" uniqKey="Van De Sompel A" first="Ariëlla" last="Van De Sompel">Ariëlla Van De Sompel</name><affiliation wicri:level="4"><nlm:affiliation>Department of Applied Mathematics, Computer Sciences and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Applied Mathematics, Computer Sciences and Statistics, Faculty of Sciences, Ghent University, Ghent</wicri:regionArea><orgName type="university">Université de Gand</orgName><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName></affiliation></author><author><name sortKey="Vansteelandt, Stijn" sort="Vansteelandt, Stijn" uniqKey="Vansteelandt S" first="Stijn" last="Vansteelandt">Stijn Vansteelandt</name><affiliation wicri:level="4"><nlm:affiliation>Department of Applied Mathematics, Computer Sciences and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Applied Mathematics, Computer Sciences and Statistics, Faculty of Sciences, Ghent University, Ghent</wicri:regionArea><orgName type="university">Université de Gand</orgName><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName></affiliation></author><author><name sortKey="Vlerick, Peter" sort="Vlerick, Peter" uniqKey="Vlerick P" first="Peter" last="Vlerick">Peter Vlerick</name><affiliation wicri:level="4"><nlm:affiliation>Department of Personnel Management, Work and Organizational Psychology, Ghent University, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Personnel Management, Work and Organizational Psychology, Ghent University, Ghent</wicri:regionArea><orgName type="university">Université de Gand</orgName><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName></affiliation></author><author><name sortKey="Vanheule, Stijn" sort="Vanheule, Stijn" uniqKey="Vanheule S" first="Stijn" last="Vanheule">Stijn Vanheule</name><affiliation wicri:level="4"><nlm:affiliation>Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent</wicri:regionArea><orgName type="university">Université de Gand</orgName><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName></affiliation></author><author><name sortKey="Benoit, Dominique D" sort="Benoit, Dominique D" uniqKey="Benoit D" first="Dominique D" last="Benoit">Dominique D. Benoit</name><affiliation wicri:level="1"><nlm:affiliation>Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care Medicine, Ghent University Hospital, Ghent</wicri:regionArea><wicri:noRegion>Ghent</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2018">2018</date><idno type="RBID">pubmed:29475979</idno><idno type="pmid">29475979</idno><idno type="doi">10.1136/bmjqs-2017-007390</idno><idno type="wicri:Area/Main/Corpus">000908</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000908</idno><idno type="wicri:Area/Main/Curation">000908</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000908</idno><idno type="wicri:Area/Main/Exploration">000908</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Ethical decision-making climate in the ICU: theoretical framework and validation of a self-assessment tool.</title><author><name sortKey="Van Den Bulcke, Bo" sort="Van Den Bulcke, Bo" uniqKey="Van Den Bulcke B" first="Bo" last="Van Den Bulcke">Bo Van Den Bulcke</name><affiliation wicri:level="1"><nlm:affiliation>Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care Medicine, Ghent University Hospital, Ghent</wicri:regionArea><wicri:noRegion>Ghent</wicri:noRegion></affiliation></author><author><name sortKey="Piers, Ruth" sort="Piers, Ruth" uniqKey="Piers R" first="Ruth" last="Piers">Ruth Piers</name><affiliation wicri:level="1"><nlm:affiliation>Geriatrics, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Geriatrics, Department of Internal Medicine, Ghent University Hospital, Ghent</wicri:regionArea><wicri:noRegion>Ghent</wicri:noRegion></affiliation></author><author><name sortKey="Jensen, Hanne Irene" sort="Jensen, Hanne Irene" uniqKey="Jensen H" first="Hanne Irene" last="Jensen">Hanne Irene Jensen</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesiology and Intensive Care, Sygehus Lillebælt Vejle Sygehus, Vejle, Denmark.</nlm:affiliation><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Anaesthesiology and Intensive Care, Sygehus Lillebælt Vejle Sygehus, Vejle</wicri:regionArea><wicri:noRegion>Vejle</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>Institute of Health Research, University of Southern Denmark, Odense, Denmark.</nlm:affiliation><country xml:lang="fr">Danemark</country><wicri:regionArea>Institute of Health Research, University of Southern Denmark, Odense</wicri:regionArea><wicri:noRegion>Odense</wicri:noRegion></affiliation></author><author><name sortKey="Malmgren, Johan" sort="Malmgren, Johan" uniqKey="Malmgren J" first="Johan" last="Malmgren">Johan Malmgren</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.</nlm:affiliation><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg</wicri:regionArea><wicri:noRegion>Gothenburg</wicri:noRegion></affiliation></author><author><name sortKey="Metaxa, Victoria" sort="Metaxa, Victoria" uniqKey="Metaxa V" first="Victoria" last="Metaxa">Victoria Metaxa</name><affiliation wicri:level="3"><nlm:affiliation>King's College Hospital, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>King's College Hospital, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Reyners, Anna K" sort="Reyners, Anna K" uniqKey="Reyners A" first="Anna K" last="Reyners">Anna K. Reyners</name><affiliation wicri:level="4"><nlm:affiliation>Department of Medical Oncology, University of Groningen, Groningen, Netherlands.</nlm:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Medical Oncology, University of Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName><orgName type="university">Université de Groningue</orgName></affiliation></author><author><name sortKey="Darmon, Michael" sort="Darmon, Michael" uniqKey="Darmon M" first="Michael" last="Darmon">Michael Darmon</name><affiliation wicri:level="3"><nlm:affiliation>Medical-Surgical Intensive Care Unit, Hopital NordSaint-Etienne University Hospital, Saint-Etienne, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Medical-Surgical Intensive Care Unit, Hopital NordSaint-Etienne University Hospital, Saint-Etienne</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Saint-Étienne</settlement></placeName></affiliation></author><author><name sortKey="Rusinova, Katerina" sort="Rusinova, Katerina" uniqKey="Rusinova K" first="Katerina" last="Rusinova">Katerina Rusinova</name><affiliation wicri:level="3"><nlm:affiliation>Department of Anaesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.</nlm:affiliation><country xml:lang="fr">République tchèque</country><wicri:regionArea>Department of Anaesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague</wicri:regionArea><placeName><settlement type="city">Prague</settlement><region type="région" nuts="2">Bohême centrale</region></placeName></affiliation></author><author><name sortKey="Talmor, Daniel" sort="Talmor, Daniel" uniqKey="Talmor D" first="Daniel" last="Talmor">Daniel Talmor</name><affiliation wicri:level="2"><nlm:affiliation>Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Meert, Anne Pascale" sort="Meert, Anne Pascale" uniqKey="Meert A" first="Anne-Pascale" last="Meert">Anne-Pascale Meert</name><affiliation wicri:level="3"><nlm:affiliation>Service des Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, ULB, Bruxelles, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Service des Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, ULB, Bruxelles</wicri:regionArea><placeName><settlement type="city">Bruxelles</settlement><region nuts="2">Région de Bruxelles-Capitale</region></placeName></affiliation></author><author><name sortKey="Cancelliere, Laura" sort="Cancelliere, Laura" uniqKey="Cancelliere L" first="Laura" last="Cancelliere">Laura Cancelliere</name><affiliation wicri:level="1"><nlm:affiliation>SCDU Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria, 'Maggiore della Carità', Novara, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>SCDU Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria, 'Maggiore della Carità', Novara</wicri:regionArea><wicri:noRegion>Novara</wicri:noRegion></affiliation></author><author><name sortKey="Zubek, Laszl" sort="Zubek, Laszl" uniqKey="Zubek L" first="Làszl" last="Zubek">Làszl Zubek</name><affiliation wicri:level="3"><nlm:affiliation>Department of Anesthesiology and Intensive Therapy, Semmelweis University Budapest, Budapest, Hungary.</nlm:affiliation><country xml:lang="fr">Hongrie</country><wicri:regionArea>Department of Anesthesiology and Intensive Therapy, Semmelweis University Budapest, Budapest</wicri:regionArea><placeName><settlement type="city">Budapest</settlement><region nuts="2">Hongrie centrale</region></placeName></affiliation></author><author><name sortKey="Maia, Paolo" sort="Maia, Paolo" uniqKey="Maia P" first="Paolo" last="Maia">Paolo Maia</name><affiliation wicri:level="1"><nlm:affiliation>Department of Intensive Care, Hospital de Santo António, Porto, Portugal.</nlm:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>Department of Intensive Care, Hospital de Santo António, Porto</wicri:regionArea><wicri:noRegion>Porto</wicri:noRegion></affiliation></author><author><name sortKey="Michalsen, Andrej" sort="Michalsen, Andrej" uniqKey="Michalsen A" first="Andrej" last="Michalsen">Andrej Michalsen</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesiology and Critical Care Medicine, Tettnang Hospital, Tettnang, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Anaesthesiology and Critical Care Medicine, Tettnang Hospital, Tettnang</wicri:regionArea><wicri:noRegion>Tettnang</wicri:noRegion><wicri:noRegion>Tettnang</wicri:noRegion><wicri:noRegion>Tettnang</wicri:noRegion></affiliation></author><author><name sortKey="Decruyenaere, Johan" sort="Decruyenaere, Johan" uniqKey="Decruyenaere J" first="Johan" last="Decruyenaere">Johan Decruyenaere</name><affiliation wicri:level="1"><nlm:affiliation>Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care Medicine, Ghent University Hospital, Ghent</wicri:regionArea><wicri:noRegion>Ghent</wicri:noRegion></affiliation></author><author><name sortKey="Kompanje, Erwin J O" sort="Kompanje, Erwin J O" uniqKey="Kompanje E" first="Erwin J O" last="Kompanje">Erwin J O. Kompanje</name><affiliation wicri:level="3"><nlm:affiliation>Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.</nlm:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, Rotterdam</wicri:regionArea><placeName><settlement type="city">Rotterdam</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Azoulay, Elie" sort="Azoulay, Elie" uniqKey="Azoulay E" first="Elie" last="Azoulay">Elie Azoulay</name><affiliation wicri:level="3"><nlm:affiliation>Medical Intensive Care Unit, Hôpital Saint-Louis and University Paris-7, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Medical Intensive Care Unit, Hôpital Saint-Louis and University Paris-7, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Meganck, Reitske" sort="Meganck, Reitske" uniqKey="Meganck R" first="Reitske" last="Meganck">Reitske Meganck</name><affiliation wicri:level="4"><nlm:affiliation>Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent</wicri:regionArea><orgName type="university">Université de Gand</orgName><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName></affiliation></author><author><name sortKey="Van De Sompel, Ariella" sort="Van De Sompel, Ariella" uniqKey="Van De Sompel A" first="Ariëlla" last="Van De Sompel">Ariëlla Van De Sompel</name><affiliation wicri:level="4"><nlm:affiliation>Department of Applied Mathematics, Computer Sciences and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Applied Mathematics, Computer Sciences and Statistics, Faculty of Sciences, Ghent University, Ghent</wicri:regionArea><orgName type="university">Université de Gand</orgName><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName></affiliation></author><author><name sortKey="Vansteelandt, Stijn" sort="Vansteelandt, Stijn" uniqKey="Vansteelandt S" first="Stijn" last="Vansteelandt">Stijn Vansteelandt</name><affiliation wicri:level="4"><nlm:affiliation>Department of Applied Mathematics, Computer Sciences and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Applied Mathematics, Computer Sciences and Statistics, Faculty of Sciences, Ghent University, Ghent</wicri:regionArea><orgName type="university">Université de Gand</orgName><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName></affiliation></author><author><name sortKey="Vlerick, Peter" sort="Vlerick, Peter" uniqKey="Vlerick P" first="Peter" last="Vlerick">Peter Vlerick</name><affiliation wicri:level="4"><nlm:affiliation>Department of Personnel Management, Work and Organizational Psychology, Ghent University, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Personnel Management, Work and Organizational Psychology, Ghent University, Ghent</wicri:regionArea><orgName type="university">Université de Gand</orgName><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName></affiliation></author><author><name sortKey="Vanheule, Stijn" sort="Vanheule, Stijn" uniqKey="Vanheule S" first="Stijn" last="Vanheule">Stijn Vanheule</name><affiliation wicri:level="4"><nlm:affiliation>Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent</wicri:regionArea><orgName type="university">Université de Gand</orgName><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName></affiliation></author><author><name sortKey="Benoit, Dominique D" sort="Benoit, Dominique D" uniqKey="Benoit D" first="Dominique D" last="Benoit">Dominique D. Benoit</name><affiliation wicri:level="1"><nlm:affiliation>Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care Medicine, Ghent University Hospital, Ghent</wicri:regionArea><wicri:noRegion>Ghent</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMJ quality & safety</title><idno type="eISSN">2044-5423</idno><imprint><date when="2018" type="published">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Decision Making (ethics)</term><term>Humans (MeSH)</term><term>Intensive Care Units (MeSH)</term><term>Medical Staff, Hospital (MeSH)</term><term>Models, Theoretical (MeSH)</term><term>Organizational Culture (MeSH)</term><term>Self-Assessment (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Auto-évaluation (psychologie) (MeSH)</term><term>Culture organisationnelle (MeSH)</term><term>Humains (MeSH)</term><term>Modèles théoriques (MeSH)</term><term>Personnel médical hospitalier (MeSH)</term><term>Prise de décision (éthique)</term><term>Unités de soins intensifs (MeSH)</term></keywords><keywords scheme="MESH" qualifier="ethics" xml:lang="en"><term>Decision Making</term></keywords><keywords scheme="MESH" qualifier="éthique" xml:lang="fr"><term>Prise de décision</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Humans</term><term>Intensive Care Units</term><term>Medical Staff, Hospital</term><term>Models, Theoretical</term><term>Organizational Culture</term><term>Self-Assessment</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Auto-évaluation (psychologie)</term><term>Culture organisationnelle</term><term>Humains</term><term>Modèles théoriques</term><term>Personnel médical hospitalier</term><term>Unités de soins intensifs</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Literature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU).</p></div><div type="abstract" xml:lang="en"><p><b>OBJECTIVES</b></p><p>To better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Using a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment. This instrument was subsequently validated among clinicians working in 68 adult ICUs in 13 European countries and the USA. Exploratory and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians. Measurement invariance was tested to make sure that variables used in the analysis were comparable constructs across different groups.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Of 3610 nurses and 1137 physicians providing ICU bedside care, 2275 (63.1%) and 717 (62.9%) participated respectively. Statistical analyses revealed that a shortened 32-item version of the EDMCQ scale provides a factorial valid measurement of seven facets of the extent to which clinicians perceive an EDM climate: self-reflective and empowering leadership by physicians; practice and culture of open interdisciplinary reflection; culture of not avoiding end-of-life decisions; culture of mutual respect within the interdisciplinary team; active involvement of nurses in end-of-life care and decision-making; active decision-making by physicians; and practice and culture of ethical awareness. Measurement invariance of the EDMCQ across occupational groups was shown, reflecting that nurses and physicians interpret the EDMCQ items in a similar manner.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>The 32-item version of the EDMCQ might enrich the EDM climate measurement, clinicians' behaviour and the performance of healthcare organisations. This instrument offers opportunities to develop tailored ICU team interventions.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">29475979</PMID><DateCompleted><Year>2019</Year><Month>10</Month><Day>08</Day></DateCompleted><DateRevised><Year>2019</Year><Month>12</Month><Day>10</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">2044-5423</ISSN><JournalIssue CitedMedium="Internet"><Volume>27</Volume><Issue>10</Issue><PubDate><Year>2018</Year><Month>10</Month></PubDate></JournalIssue><Title>BMJ quality & safety</Title><ISOAbbreviation>BMJ Qual Saf</ISOAbbreviation></Journal><ArticleTitle>Ethical decision-making climate in the ICU: theoretical framework and validation of a self-assessment tool.</ArticleTitle><Pagination><MedlinePgn>781-789</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1136/bmjqs-2017-007390</ELocationID><Abstract><AbstractText Label="BACKGROUND">Literature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU).</AbstractText><AbstractText Label="OBJECTIVES">To better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates.</AbstractText><AbstractText Label="METHODS">Using a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment. This instrument was subsequently validated among clinicians working in 68 adult ICUs in 13 European countries and the USA. Exploratory and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians. Measurement invariance was tested to make sure that variables used in the analysis were comparable constructs across different groups.</AbstractText><AbstractText Label="RESULTS">Of 3610 nurses and 1137 physicians providing ICU bedside care, 2275 (63.1%) and 717 (62.9%) participated respectively. Statistical analyses revealed that a shortened 32-item version of the EDMCQ scale provides a factorial valid measurement of seven facets of the extent to which clinicians perceive an EDM climate: self-reflective and empowering leadership by physicians; practice and culture of open interdisciplinary reflection; culture of not avoiding end-of-life decisions; culture of mutual respect within the interdisciplinary team; active involvement of nurses in end-of-life care and decision-making; active decision-making by physicians; and practice and culture of ethical awareness. Measurement invariance of the EDMCQ across occupational groups was shown, reflecting that nurses and physicians interpret the EDMCQ items in a similar manner.</AbstractText><AbstractText Label="CONCLUSIONS">The 32-item version of the EDMCQ might enrich the EDM climate measurement, clinicians' behaviour and the performance of healthcare organisations. This instrument offers opportunities to develop tailored ICU team interventions.</AbstractText><CopyrightInformation>© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Van den Bulcke</LastName><ForeName>Bo</ForeName><Initials>B</Initials><Identifier Source="ORCID">0000-0001-5379-8886</Identifier><AffiliationInfo><Affiliation>Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Piers</LastName><ForeName>Ruth</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Geriatrics, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jensen</LastName><ForeName>Hanne Irene</ForeName><Initials>HI</Initials><AffiliationInfo><Affiliation>Department of Anaesthesiology and Intensive Care, Sygehus Lillebælt Vejle Sygehus, Vejle, Denmark.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Institute of Health Research, University of Southern Denmark, Odense, Denmark.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Malmgren</LastName><ForeName>Johan</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Metaxa</LastName><ForeName>Victoria</ForeName><Initials>V</Initials><AffiliationInfo><Affiliation>King's College Hospital, London, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Reyners</LastName><ForeName>Anna K</ForeName><Initials>AK</Initials><AffiliationInfo><Affiliation>Department of Medical Oncology, University of Groningen, Groningen, Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Darmon</LastName><ForeName>Michael</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Medical-Surgical Intensive Care Unit, Hopital NordSaint-Etienne University Hospital, Saint-Etienne, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rusinova</LastName><ForeName>Katerina</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Department of Anaesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Talmor</LastName><ForeName>Daniel</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Meert</LastName><ForeName>Anne-Pascale</ForeName><Initials>AP</Initials><AffiliationInfo><Affiliation>Service des Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, ULB, Bruxelles, Belgium.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cancelliere</LastName><ForeName>Laura</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>SCDU Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria, 'Maggiore della Carità', Novara, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zubek</LastName><ForeName>Làszló</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology and Intensive Therapy, Semmelweis University Budapest, Budapest, Hungary.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Maia</LastName><ForeName>Paolo</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Department of Intensive Care, Hospital de Santo António, Porto, Portugal.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Michalsen</LastName><ForeName>Andrej</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Anaesthesiology and Critical Care Medicine, Tettnang Hospital, Tettnang, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Decruyenaere</LastName><ForeName>Johan</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kompanje</LastName><ForeName>Erwin J O</ForeName><Initials>EJO</Initials><AffiliationInfo><Affiliation>Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Azoulay</LastName><ForeName>Elie</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Medical Intensive Care Unit, Hôpital Saint-Louis and University Paris-7, Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Meganck</LastName><ForeName>Reitske</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Van de Sompel</LastName><ForeName>Ariëlla</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Applied Mathematics, Computer Sciences and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vansteelandt</LastName><ForeName>Stijn</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Applied Mathematics, Computer Sciences and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vlerick</LastName><ForeName>Peter</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Department of Personnel Management, Work and Organizational Psychology, Ghent University, Ghent, Belgium.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vanheule</LastName><ForeName>Stijn</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Benoit</LastName><ForeName>Dominique D</ForeName><Initials>DD</Initials><AffiliationInfo><Affiliation>Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType><PublicationType UI="D023361">Validation Study</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2018</Year><Month>02</Month><Day>23</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>BMJ Qual Saf</MedlineTA><NlmUniqueID>101546984</NlmUniqueID><ISSNLinking>2044-5415</ISSNLinking></MedlineJournalInfo><CitationSubset>H</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>BMJ Qual Saf. 2018 Oct;27(10):766-770</RefSource><PMID Version="1">29669857</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D003657" MajorTopicYN="N">Decision Making</DescriptorName><QualifierName UI="Q000941" MajorTopicYN="Y">ethics</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007362" MajorTopicYN="Y">Intensive Care Units</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008505" MajorTopicYN="N">Medical Staff, Hospital</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008962" MajorTopicYN="N">Models, Theoretical</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015279" MajorTopicYN="Y">Organizational Culture</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012647" MajorTopicYN="Y">Self-Assessment</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">communication</Keyword><Keyword MajorTopicYN="Y">critical care</Keyword><Keyword MajorTopicYN="Y">decision-making</Keyword><Keyword MajorTopicYN="Y">teamwork</Keyword></KeywordList><CoiStatement>Competing interests: None declared.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2017</Year><Month>09</Month><Day>14</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2017</Year><Month>12</Month><Day>26</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2018</Year><Month>02</Month><Day>01</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2018</Year><Month>2</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2019</Year><Month>10</Month><Day>9</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2018</Year><Month>2</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">29475979</ArticleId><ArticleId IdType="pii">bmjqs-2017-007390</ArticleId><ArticleId IdType="doi">10.1136/bmjqs-2017-007390</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Allemagne</li><li>Belgique</li><li>Danemark</li><li>France</li><li>Hongrie</li><li>Italie</li><li>Pays-Bas</li><li>Portugal</li><li>Royaume-Uni</li><li>République tchèque</li><li>Suède</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Auvergne-Rhône-Alpes</li><li>Bohême centrale</li><li>Grand Londres</li><li>Groningue (province)</li><li>Hollande-Méridionale</li><li>Hongrie centrale</li><li>Massachusetts</li><li>Province de Flandre-Orientale</li><li>Rhône-Alpes</li><li>Région de Bruxelles-Capitale</li><li>Région flamande</li><li>Île-de-France</li></region><settlement><li>Bruxelles</li><li>Budapest</li><li>Gand</li><li>Groningue</li><li>Londres</li><li>Paris</li><li>Prague</li><li>Rotterdam</li><li>Saint-Étienne</li></settlement><orgName><li>Université de Gand</li><li>Université de Groningue</li></orgName></list><tree><country name="Belgique"><noRegion><name sortKey="Van Den Bulcke, Bo" sort="Van Den Bulcke, Bo" uniqKey="Van Den Bulcke B" first="Bo" last="Van Den Bulcke">Bo Van Den Bulcke</name></noRegion><name sortKey="Benoit, Dominique D" sort="Benoit, Dominique D" uniqKey="Benoit D" first="Dominique D" last="Benoit">Dominique D. Benoit</name><name sortKey="Decruyenaere, Johan" sort="Decruyenaere, Johan" uniqKey="Decruyenaere J" first="Johan" last="Decruyenaere">Johan Decruyenaere</name><name sortKey="Meert, Anne Pascale" sort="Meert, Anne Pascale" uniqKey="Meert A" first="Anne-Pascale" last="Meert">Anne-Pascale Meert</name><name sortKey="Meganck, Reitske" sort="Meganck, Reitske" uniqKey="Meganck R" first="Reitske" last="Meganck">Reitske Meganck</name><name sortKey="Piers, Ruth" sort="Piers, Ruth" uniqKey="Piers R" first="Ruth" last="Piers">Ruth Piers</name><name sortKey="Van De Sompel, Ariella" sort="Van De Sompel, Ariella" uniqKey="Van De Sompel A" first="Ariëlla" last="Van De Sompel">Ariëlla Van De Sompel</name><name sortKey="Vanheule, Stijn" sort="Vanheule, Stijn" uniqKey="Vanheule S" first="Stijn" last="Vanheule">Stijn Vanheule</name><name sortKey="Vansteelandt, Stijn" sort="Vansteelandt, Stijn" uniqKey="Vansteelandt S" first="Stijn" last="Vansteelandt">Stijn Vansteelandt</name><name sortKey="Vlerick, Peter" sort="Vlerick, Peter" uniqKey="Vlerick P" first="Peter" last="Vlerick">Peter Vlerick</name></country><country name="Danemark"><noRegion><name sortKey="Jensen, Hanne Irene" sort="Jensen, Hanne Irene" uniqKey="Jensen H" first="Hanne Irene" last="Jensen">Hanne Irene Jensen</name></noRegion><name sortKey="Jensen, Hanne Irene" sort="Jensen, Hanne Irene" uniqKey="Jensen H" first="Hanne Irene" last="Jensen">Hanne Irene Jensen</name></country><country name="Suède"><noRegion><name sortKey="Malmgren, Johan" sort="Malmgren, Johan" uniqKey="Malmgren J" first="Johan" last="Malmgren">Johan Malmgren</name></noRegion></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Metaxa, Victoria" sort="Metaxa, Victoria" uniqKey="Metaxa V" first="Victoria" last="Metaxa">Victoria Metaxa</name></region></country><country name="Pays-Bas"><region name="Groningue (province)"><name sortKey="Reyners, Anna K" sort="Reyners, Anna K" uniqKey="Reyners A" first="Anna K" last="Reyners">Anna K. Reyners</name></region><name sortKey="Kompanje, Erwin J O" sort="Kompanje, Erwin J O" uniqKey="Kompanje E" first="Erwin J O" last="Kompanje">Erwin J O. Kompanje</name></country><country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Darmon, Michael" sort="Darmon, Michael" uniqKey="Darmon M" first="Michael" last="Darmon">Michael Darmon</name></region><name sortKey="Azoulay, Elie" sort="Azoulay, Elie" uniqKey="Azoulay E" first="Elie" last="Azoulay">Elie Azoulay</name></country><country name="République tchèque"><region name="Bohême centrale"><name sortKey="Rusinova, Katerina" sort="Rusinova, Katerina" uniqKey="Rusinova K" first="Katerina" last="Rusinova">Katerina Rusinova</name></region></country><country name="États-Unis"><region name="Massachusetts"><name sortKey="Talmor, Daniel" sort="Talmor, Daniel" uniqKey="Talmor D" first="Daniel" last="Talmor">Daniel Talmor</name></region></country><country name="Italie"><noRegion><name sortKey="Cancelliere, Laura" sort="Cancelliere, Laura" uniqKey="Cancelliere L" first="Laura" last="Cancelliere">Laura Cancelliere</name></noRegion></country><country name="Hongrie"><region name="Hongrie centrale"><name sortKey="Zubek, Laszl" sort="Zubek, Laszl" uniqKey="Zubek L" first="Làszl" last="Zubek">Làszl Zubek</name></region></country><country name="Portugal"><noRegion><name sortKey="Maia, Paolo" sort="Maia, Paolo" uniqKey="Maia P" first="Paolo" last="Maia">Paolo Maia</name></noRegion></country><country name="Allemagne"><noRegion><name sortKey="Michalsen, Andrej" sort="Michalsen, Andrej" uniqKey="Michalsen A" first="Andrej" last="Michalsen">Andrej Michalsen</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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