How doctors manage conflicts with families of critically ill patients during conversations about end-of-life decisions in neonatal, pediatric, and adult intensive care
Issued Date
2022-07-01
Resource Type
ISSN
03424642
eISSN
14321238
Scopus ID
2-s2.0-85133188319
Pubmed ID
35773499
Journal Title
Intensive Care Medicine
Volume
48
Issue
7
Start Page
910
End Page
922
Rights Holder(s)
SCOPUS
Bibliographic Citation
Intensive Care Medicine Vol.48 No.7 (2022) , 910-922
Suggested Citation
Spijkers A.S., Akkermans A., Smets E.M.A., Schultz M.J., Cherpanath T.G.V., van Woensel J.B.M., van Heerde M., van Kaam A.H., van de Loo M., Willems D.L., de Vos M.A. How doctors manage conflicts with families of critically ill patients during conversations about end-of-life decisions in neonatal, pediatric, and adult intensive care. Intensive Care Medicine Vol.48 No.7 (2022) , 910-922. 922. doi:10.1007/s00134-022-06771-5 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85760
Title
How doctors manage conflicts with families of critically ill patients during conversations about end-of-life decisions in neonatal, pediatric, and adult intensive care
Other Contributor(s)
Abstract
Purpose: Intensive care is a stressful environment in which team-family conflicts commonly occur. If managed poorly, conflicts can have negative effects on all parties involved. Previous studies mainly investigated these conflicts and their management in a retrospective way. This study aimed to prospectively explore team-family conflicts, including its main topics, complicating factors, doctors’ conflict management strategies and the effect of these strategies. Methods: Conversations between doctors in the neonatal, pediatric, and adult intensive care unit of a large university-based hospital and families of critically ill patients were audio-recorded from the moment doubts arose whether treatment was still in patients’ best interest. Transcripts were coded and analyzed using a qualitative deductive approach. Results: Team-family conflicts occurred in 29 out of 101 conversations (29%) concerning 20 out of 36 patients (56%). Conflicts mostly concerned more than one topic. We identified four complicating context- and/or family-related factors: diagnostic and prognostic uncertainty, families’ strong negative emotions, limited health literacy, and burden of responsibility. Doctors used four overarching strategies to manage conflicts, namely content-oriented, process-oriented, moral and empathic strategies. Doctors mostly used content-oriented strategies, independent of the intensive care setting. They were able to effectively address conflicts in most conversations. Yet, if they did not acknowledge families’ cues indicating the existence of one or more complicating factors, conflicts were likely to linger on during the conversation. Conclusion: This study underlines the importance of doctors tailoring their communication strategies to the concrete conflict topic(s) and to the context- and family-related factors which complicate a specific conflict.