Publication: How doctors actually (do not) involve families in decisions to continue or discontinue life-sustaining treatment in neonatal, pediatric, and adult intensive care: A qualitative study
Issued Date
2021-12-01
Resource Type
ISSN
1477030X
02692163
02692163
Other identifier(s)
2-s2.0-85108834811
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Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
Palliative Medicine. Vol.35, No.10 (2021), 1865-1877
Suggested Citation
Aranka Akkermans, J. M.W.J. Lamerichs, M. J. Schultz, T. G.V. Cherpanath, J. B.M. van Woensel, Marc van Heerde, A. H.L.C. van Kaam, M. D. van de Loo, A. M. Stiggelbout, E. M.A. Smets, M. A. de Vos How doctors actually (do not) involve families in decisions to continue or discontinue life-sustaining treatment in neonatal, pediatric, and adult intensive care: A qualitative study. Palliative Medicine. Vol.35, No.10 (2021), 1865-1877. doi:10.1177/02692163211028079 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/77567
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Title
How doctors actually (do not) involve families in decisions to continue or discontinue life-sustaining treatment in neonatal, pediatric, and adult intensive care: A qualitative study
Abstract
Background: Intensive care doctors have to find the right balance between sharing crucial decisions with families of patients on the one hand and not overburdening them on the other hand. This requires a tailored approach instead of a model based approach. Aim: To explore how doctors involve families in the decision-making process regarding life-sustaining treatment on the neonatal, pediatric, and adult intensive care. Design: Exploratory inductive thematic analysis of 101 audio-recorded conversations. Setting/participants: One hundred four family members (61% female, 39% male) and 71 doctors (60% female, 40% male) of 36 patients (53% female, 47% male) from the neonatal, pediatric, and adult intensive care of a large university medical center participated. Results: We identified eight relevant and distinct communicative behaviors. Doctors’ sequential communicative behaviors either reflected consistent approaches—a shared approach or a physician-driven approach—or reflected vacillating between both approaches. Doctors more often displayed a physician-driven or a vacillating approach than a shared approach, especially in the adult intensive care. Doctors did not verify whether their chosen approach matched the families’ decision-making preferences. Conclusions: Even though tailoring doctors’ communication to families’ preferences is advocated, it does not seem to be integrated into actual practice. To allow for true tailoring, doctors’ awareness regarding the impact of their communicative behaviors is key. Educational initiatives should focus especially on improving doctors’ skills in tactfully exploring families’ decision-making preferences and in mutually sharing knowledge, values, and treatment preferences.