Martine Kruijtbosch

30 Chap t e r 2 .1 METHODS Study design and setting Pharmacists wrote a narrative of a moral dilemma they had experienced in clinical practice, as an assignment during either pre- or postgraduate training. The pharmacists were asked to write this narrative immediately after they had experienced the dilemma. A stratified random sample of these narratives was taken. All pharmacists had been taught how to recognise moral dilemmas. This study followed scientific standards for reporting qualitative research (SRQR; Appendix). 42, 43 Definition of moral dilemmas On the basis of the various definitions in the literature 25, 29, 35, 40, 44, 45 , a ‘moral dilemma’ was defined as: a situation in which there is a choice between at least two courses of action, neither of which is obviously morally preferable . Narratives were checked against this working definition by both the first author (MK) and a member of an expert panel consisting of eleven senior pharmacists active in the special interest group on pharmacy ethics of the Royal Dutch Pharmacists Association. All panellists had been trained in a half-day ethics course to identify moral dilemmas. If consensus was not reached, a third pharmacist from the research group (WG, MB or AF) was consulted. Narratives that did not comply with our working definition were excluded. Data analysis Inductive content analysis of narratives to identify themes of moral dilemmas was facilitated with ATLAS.ti (version 7.5.17). 46 Consensus on final themes and main categories was reached in two rounds, during independent validation by the research group and during a consensus meeting with both the expert panel and research group. RESULTS Of the 220 narratives, 92 were excluded (Figure 1). The included 128 narratives were written by pregraduates (49%: 51%male; 49% female) and postgraduates (51%: 39%male, 61% female). Twenty-two themes were identified, divided into three main categories (see Table 1). Below, we illustrate the themes with a brief summary of a dilemma and quotes from pharmacists that reflect the essence of the theme.