Martine Kruijtbosch

99 Mo ra l r eason i ng pe r spec t i ves i n s i t ua t i on s o f d rug s ho r t ages their intended action either negatively or positively, as all respondents have experienced the shortages in their pharmacy. The respondents then had to rate the extent to which 13 considerations played a role in handling the drug shortage problem using a five-point scale (very strong, strong, weakly, very weakly, no role). This five-point scale from very strong to no role was chosen because a consideration might not play a role in the intended actions. Finally, the respondents had to rank the four most relevant considerations. Participants also answered general questions about their gender, age, type of pharmacy and job profile. Measuring moral reasoning perspectives The profession-specific moral reasoning measure developed for this study was based on earlier research. 46,49 In that research, based on Kohlberg’s cognitive moral development theory and the DIT, 28 Rest’s three MRPs have been adjusted to the community pharmacy practice context: (1) at the pre-conventional level, pharmacists’ MRP is focused onmaintaining a viable business and included personal interests (this MRP has been named business orientation and is labelled BO-MRP); (2) at the conventional level, pharmacists’ MRP is centred around adhering to rules and regulations (this MRP has been named rules and regulations and is labelled RR-MRP); and (3) at the post-conventional level, pharmacists’ MRP is guided by professional ethics (this MRP has been named professional ethics and is labelled PE-MRP). 16,49 In this study, the research team (MK, AF and MB) designed the to be rated and ranked considerations for these MRPs in the context of the three drug shortages and the professional values of Dutch pharmacy practice. 47,48 The team used the three drug shortage scenarios to develop four different considerations for each MRP. Some considerations were used in more than one scenario. Validation of the survey The survey was validated by using an intensive process to reach consensus between the research team (MK, AF and MB) and an expert panel of five experienced pharmacists over the course of three meetings. All five pharmacists were active in the special interest group on pharmacy ethics of the Royal Dutch Pharmacists Association. Four of the five experts were also practicing senior community pharmacists. First, the accuracy, readability and content of the drug shortage scenarios, options of intended action and considerations were assessed. Further, every consideration was judged on its representation of the MRP, which for the PE-considerations contains the professional values. 47 If no consensus was reached, a consideration was reformulated or discarded. The top four considerations for each MRP and scenario were chosen for use in the survey. The entire survey was tested by seven community pharmacists to make final adjustments.