Luppo Kuillman

Summarizing Discussion and Future Research Directions 135 6 With respect to the main findings of having validated two novel scales measuring a moral deliberative attitude (MSQ-DELIB) and a paternalistic attitude (MSQ-PATER), as reported in Chapter 2 of this doctoral thesis, it can be stated that both scales can be introduced in both educational as also professional practice. The scales can be administered among PA and NP students and professionals to measure their morally deliberative and paternalistic attitudes, respectively. However, the MSQ-DELIB could also be used as a diagnostic tool towards estimating the propensity of yielding to pressure. After all, this has been a finding in the study as being reported in Chapter 5 , where it was found that individuals with a high degree of a morally deliberative attitude are at risk of yielding to pressure when this occurs within a direct provider- patient interaction. When the pressure occurred within a professional interaction, there was no risk of yielding to pressure. However, the reason why this occurred is subject to further research. With respect to the effect occurring in the direct provider- patient interaction, one can imagine that during training, especially students who have a high degree of a morally deliberative attitude should be made aware of the risks of yielding to pressure and to prevent them end up making unethical choices. This could be elucidated during training sessions, including simulated patient encounters where the patient plays a demanding role. In this, it is also of a paramount importance to prepare the students to such possible situations and also make them learn to recognize the emotional patterns involved. The last could be very well orchestrated during moral case deliberation sessions with peers (Molewijk, Kleinlugtenbelt, & Widdershoven, 2011). Regarding the paternalistic attitude, against all odds, we have not been able to validate the predictive value towards (un)ethical behavior. Even though the scale MSQ-PATER could function as an appropriate ‘thermometer’ to get an indication to which extent someone has a paternalistic attitude, for now, it does not go any further than that. We can imagine that the scale might demonstrate added value towards subjects of, for example, shared decision-making (SDM), motivational interviewing, and other communication techniques, in which the role of both the healthcare provider and the patient must be based on equality and reciprocity to achieve treatment success upon mutual agreement (Sandman & Munthe, 2010). Furthermore, a recent study elicited that in general physicians prefer SDM but fall back to the well-known paternalistic basic attitude. As proposed by Diever et al. (2020), our MSQ-PATER could be used to raise awareness of the decision process itself (Driever, Stiggelbout, & Brand, 2020).