A. Sturm1, R. Roth1,2, A.L. Ager3
1Interuniversity College for Health and Development Graz, Castle of Seggau, Graz, Austria, 2University of Graz, Graz, Austria, 3Gent University, Doctoral School of Life Sciences and Medicine, Gent, Belgium

Background: Various factors are considered important for a physiotherapist’s ethical decision-making; however, little is known regarding the ethical views and beliefs of physiotherapists from around the world. Identifying relevant fields and convictions can inform ethical teachings, direct future research, and provide support for professional development.

Purpose: This study aims to explore physiotherapists perceptual weighting of different factors within their ethical decision-making process. We embedded such factors within written statements in order to identify realms which require awareness, preparation and/or further investigation.

Methods: A mixed-methods online survey published in English was distributed using purposeful and snowball sampling. The survey contained 44 items within three sections:
i) participants socio-demographic information (13 items),
ii) diverse statements regarding ethical codes and decision-making (30 items), and
iii) an optional opportunity (1 item) to describe additional factors which play a role in their ethical decision-making. Participants were required to express their level of agreement for each statement, using a five-point Likert scale (1=strongly disagree to 5=strongly agree). The statements represented either
a) individual factors or
b) situational/contextual/organizational factors.
The survey on average required 15 minutes to complete and was submitted anonymously. Descriptive statistics and qualitative methods were used for data analysis.

Results: 554 participants from 72 countries took part; with 415 completing the entire survey. Diverse (0.9%), males (30.7%) and females (68.4%) participated, with a mean age of 37.0 (±11.8) years (female 37.4 ±11.9, male 36.2 ±11.9, diverse 32.4 ±8.7). We analyzed participant ratios by WCPT member countries (84.1%), non-member countries (15.8%) and regions. 10.2% of participants were from Africa, 27.2% from Asia Western Pacific, 49.2% from Europe, 11.4% from North America Caribbean and 2.0% were from South America. Participants identified with the following religions: Christianity (45.2%), Secular/Atheist/Non-religious (23.6%), Hinduism (9.8%), Islam (9.6%), Buddhism (3.1%), other religions (<1%) or preferred not to share (4.9%). In the analysis of the statements, ‘the professional role of a physiotherapist obliges them to behave ethically’ obtained the highest approval rating, followed by ‘ethical decision-making requiring more skills than observing a code of conduct or ethical principles’. A recognizable organisational culture of ethical practice was clearly identified as being supportive. The way senior physiotherapists are representing the profession was identified as influencing junior physiotherapists. Although a notion of underpreparedness by basic physiotherapy training was expressed, ethical decision-making as a source of stress was rated low. Moreover, religious beliefs were rated as playing a minor role. Physiotherapists learned about ethical decision-making through both pre- and post-graduate education, on their own, from colleagues and through professional courses.

Conclusion(s): Ethical decision-making is a professional skill, continuously being acquired and adapted through formal and informal education. Factors such as own and cultural values, the context of the healthcare systems, the role and influence of colleagues and the work environment must not be underestimated. Further exploration of such factors is warranted.

Implications: Knowledge translation and participating in ethical training should be easily accessible globally. Our findings can be shared with educational and healthcare institutions in order to better prepare physiotherapists for ethical decision-making in their daily practice.

Funding, acknowledgements: The study received funding by the Government of Salzburg/Austria (Land Salzburg), Department Culture and Science

Keywords: Ethics, Decision-making, International

Topic: Professionalism & ethics

Did this work require ethics approval? Yes
Institution: Institute for Ethics and Right in Medicine (IERM), University of Vienna
Committee: IERM Dr. Stefan Dinges
Ethics number: IERM Ethics Vote 3/2018

All authors, affiliations and abstracts have been published as submitted.

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