• Aliza M Olive, Asdis Finnsdottir Wagner, Daniel T Mulhall, Tessie W October, Joanna L Hart, Ashley K Sherman, Jessica S Wallisch, and Laura Miller-Smith.
• Division of Pediatric Critical Care, Cleveland Clinic Children's Institute, Cleveland Clinic, Cleveland, OH.
• Pediatr Crit Care Me. 2024 May 1; 25 (5): 407415407-415.

ObjectivesNudging, a behavioral economics concept, subtly influences decision-making without coercion or limiting choice. Despite its frequent use, the specific application of nudging techniques by clinicians in shared decision-making (SDM) is understudied. Our aim was to analyze clinicians' use of nudging in a curated dataset of family care conferences in the PICU.DesignBetween 2019 and 2020, we retrospectively studied and coded 70 previously recorded care conference transcripts that involved physicians and families from 2015 to 2019. We focused on decision-making discussions examining instances of nudging, namely salience, framing, options, default, endowment, commission, omission, recommend, expert opinion, certainty, and social norms. Nudging instances were categorized by decision type, including tracheostomy, goals of care, or procedures.SettingSingle-center quaternary pediatric facility with general and cardiac ICUs.PatientsNone.InterventionsNone.MeasurementsWe assessed the pattern and frequency of nudges in each transcript.Main ResultsSixty-three of the 70 transcripts contained SDM episodes. These episodes represented a total of 11 decision categories based on the subject matter of nudging instances, with 308 decision episodes across all transcripts (median [interquartile range] 5 [4-6] per conference). Tracheostomy was the most frequently discussed decision. A total of 1096 nudging instances were identified across the conferences, with 8 (6-10) nudge types per conference. The most frequent nudging strategy used was gain frame (203/1096 [18.5%]), followed by loss frame (150/1096 [13.7%]).ConclusionsNudging is routinely employed by clinicians to guide decision-making, primarily through gain or loss framing. This retrospective analysis aids in understanding nudging in care conferences: it offers insight into potential risks and benefits of these techniques; it highlights ways in which their application has been used by caregivers; and it may be a resource for future trainee curriculum development.Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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