• Erin D Paquette, Lainie F Ross, Jairo Chavez, and Joel E Frader.
• Division of Critical Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
• Pediatr Crit Care Me. 2023 Aug 1; 24 (8): 628635628-635.

ObjectivesRefusals to allow examination for determination of death by neurologic criteria (DNC) challenge pediatric physicians and create distress for medical teams and families of patients suspected to meet criteria for DNC. The objective of this study was to inquire about and assess experiences with such refusals from the perspective of physicians.DesignWe conducted a mixed-methods survey and interview-based study to understand physicians' experiences with refusals.SettingAn online survey was sent to pediatric intensivists and neurologists; phone interviews were conducted in a subset.Patients/ParticipantsThe study included 80 physician survey respondents and 12 interview physician respondents.InterventionsNone.Measurements And Main ResultsRefusals occur for many reasons regarding patients with both acute and progressive brain injury. The most common reasons were consistent in surveys and interviews and include "waiting on a miracle," not wanting to give up, religious objections and disbelief in brain death. Time was an important mediator in many cases. Physicians described several approaches to managing refusals, highlighting the impact on medical teams, distraction from other patients, and need for resources to support physicians.ConclusionsRefusals may have important sociodemographic associations that should be considered in managing complex cases. Physicians seek more guidance in law and policies to manage refusals.Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

14 keywords...

hide…