Luppo Kuillman

Re-assessing the validity of the Moral Sensitivity Questionnaire 43 2 Table 2: Convergent and divergent validity of the Deliberate Attitude Scale (MSQ- DELIB) and the Paternalistic Attitude Scale (MSQ-PATER) 1 2 Alpha 1 Deliberate Attitude Scale (MSQ-DELIB) 0.70 2 Paternalistic Attitude scale (MSQ-PATER) .03 0.70 3 Behavior Control targeted at Preventing Harm (BCPH) scale .34 ** .17 * 0.72 4 Ethics Advocacy Scale (EAS) .42 ** - .06 0.72 5 Moral Disengagement Total (MDS) - .17 * .20 * 0.85 6 Defining issues test (N2-index) - .04 - .00 0.80 * p < .05; ** p < .01 DISCUSSION Prior to the current study, a feasibility study was conducted among students in a master’s program for PAs, in order to test the psychometric properties of several instruments, some of which have also been included in this study. The objectives of the feasibility study also included modifying and validating a revised version of the MSQ, as developed by Lützén and colleagues (Lützén et al., 1997), for use among NPs and PAs. In that study, however, a simple EFA using Varimax rotation revealed 10 latent components, instead of the six that were theoretically assumed by Lützén and colleagues. A subsequent narrative review of the literature revealed that international scholars building on the work of Lützén and colleagues (Borhani et al., 2017; Dalla Nora et al., 2017; Han et al., 2010; Yilmaz Sahin et al., 2015) had also been unable to reproduce the six factors proposed for the original instrument. In light of these developments, we decided not to re-evaluate the six-component structure, but instead to modify and validate a revised version of the instrument. The outcomes of the current study support the validity and reliability of two new scales: MSQ-DELIB and MSQ- PATER. These findings are obviously preliminary, given that this is the first time that the validity of these new MSQ dimensions have been evaluated among Dutch NPs and PAs. The solid methodology of this study nevertheless contributes to these two new scales, which were established through CFA to produce a two-factor solution with good model fit and satisfactory internal consistency (reliability estimates). Our findings are in line with work by Emanuel and Emanuel, who identify deliberative and paternalistic attitudes as two of the four parts of the clinician-patient relationship (the other two being informative and interpretive attitudes) (Emanuel & Emanuel,