Martine Kruijtbosch

160 Chap t e r 4 of technicians, normally only one or two pharmacists are on the work floor and have end responsibility for the pharmaceutical care of each patient. There are few chances to meet more colleagues to systematically discuss the moral dilemmas they experience in practice and share viewpoints. The two MCDs in our present study were performed once for two different groups of community pharmacists of whom the majority was not working in the same pharmacy. This may explain the enthusiasm of the participants about the MCD sessions. Some even preferred MCD to intervision meetings. As a consequence of the practice, in community pharmacy, dilemma cases will mostly be dealt with retrospectively. This may be another explanation of why the pharmacists in this study were focused on and enthusiastic about learning from each other’s moral viewpoints rather than on reaching consensus about what the best care for the patient would be. Future research should therefore also address what participants want to achieve with MCD and compare MCD aims with actual harvest. 13 This has not been studied here. Strengths and limitations First, only two MCD sessions were used for the study. This was justified because this study is explorative and of a contextual nature only. It should be followed by more qualitative and quantitative research. With two dilemma cases, this study allowed for the exploration of differences within and between the two MCD sessions and had more opportunity to show replication of the outcomes than it would if only one MCD session was explored. 28,43 The pilot helped optimize the online setting so that the best reflection could take place in the two subsequent MCD sessions. The three implemented adjustments proved successful, as participants were quickly activated and remained so throughout the MCD sessions. Also, more time for deliberation in the decision-making phase (steps 8 and 9) in the two MCD sessions resulted there in more substantial harvest than in the pilot session. The outcomes are promising enough to conduct more research. Such research should examine whether more community pharmacists are interested in online MCD and if similar outcomes can be generated. Second, the MCD sessions were not held in physical locations but through online videoconferences due to COVID-19. A disadvantage of videoconferencing is that body language can be missed by the facilitator. Also, heavy emotions due to the dilemma case cannot be adequately addressed. Although this was not the case in the MCD sessions in this study, such unaddressed heavy emotions may create an unsafe atmosphere. 44 An advantage experienced in this study was that the videoconference allowed pharmacists from cities and villages all over the Netherlands to attend the same session.