• Am J Hosp Palliat Care · Apr 2018

    Physicians Perceptions of Shared Decision-Making in Neonatal and Pediatric Critical Care.

    • Claire A Richards, Helene Starks, M Rebecca O'Connor, Erica Bourget, Ross M Hays, and Ardith Z Doorenbos.
    • 1 Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
    • Am J Hosp Palliat Care. 2018 Apr 1; 35 (4): 669-676.

    BackgroundMost children die in neonatal and pediatric intensive care units after decisions are made to withhold or withdraw life-sustaining treatments. These decisions can be challenging when there are different views about the child's best interest and when there is a lack of clarity about how best to also consider the interests of the family.ObjectiveTo understand how neonatal and pediatric critical care physicians balance and integrate the interests of the child and family in decisions about life-sustaining treatments.MethodsSemistructured interviews were conducted with 22 physicians from neonatal, pediatric, and cardiothoracic intensive care units in a single quaternary care pediatric hospital. Transcribed interviews were analyzed using content and thematic analysis.ResultsWe identified 3 main themes: (1) beliefs about child and family interests; (2) disagreement about the child's best interest; and (3) decision-making strategies, including limiting options, being directive, staying neutral, and allowing parents to come to their own conclusions. Physicians described challenges to implementing shared decision-making including unequal power and authority, clinical uncertainty, and complexity of balancing child and family interests. They acknowledged determining the level of engagement in shared decision-making with parents (vs routine engagement) based on their perceptions of the best interests of the child and parent.ConclusionsDue to power imbalances, families' values and preferences may not be integrated in decisions or families may be excluded from discussions about goals of care. We suggest that a systematic approach to identify parental preferences and needs for decisional roles and information may reduce variability in parental involvement.

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