ArticleBMJ open2019
Decision-making dilemmas of paediatricians: a qualitative study in Japan.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.
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Who cites it
6 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- A Dutch paediatric palliative care guideline: a systematic review and recommendations on advance care planning and shared decision-making.BMC palliative care · 2024Pooled it
- Physician decision-making process about withholding/withdrawing life-sustaining treatments in paediatric patients: a systematic review of qualitative evidence.BMC palliative care · 2022Pooled it
- Challenges in Clinical Decision-Making for Nurses in Neonatal Intensive Care Unit (NICU): A Qualitative Study.Critical care research and practice · 2025Article
- Palliative care for children: methodology for the development of a national clinical practice guideline.BMC palliative care · 2023Review
- Both Medical and Context Elements Influence the Decision-Making Processes of Pediatricians.Children (Basel, Switzerland) · 2022Article
- The relationship between proxy agency and the medical decisions concerning pediatric patients in palliative care: a qualitative study.BMC palliative care · 2021Article
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Authors and funding
15 authors.
Funding
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Abstract
objectiveTo delineate the critical decision-making processes that paediatricians apply when treating children with life-threatening conditions and the psychosocial experience of paediatricians involved in such care.
designWe conducted semistructured, individual face-to-face interviews for each participant from 2014 to 2015. The content of each interview was subjected to a comprehensive qualitative analysis. The categories of dilemma were extracted from a second-round content analysis.
participantsParticipants were board-certified paediatricians with sufficient experience in making decisions in relation to children with severe illnesses or disabilities. We repeated purposive sampling and analyses until we reached saturation of the category data.
resultsWe performed interviews with 15 paediatricians. They each reported both unique and overlapping categories of dilemmas that they encountered when making critical decisions. The dilemmas included five types of causal elements: (1) paediatricians' convictions; (2) the quest for the best interests of patients; (3) the quest for medically appropriate plans; (4) confronting parents and families and (5) socioenvironmental issues. Dilemmas occurred and developed as conflicting interactions among these five elements. We further categorised these five elements into three principal domains: the decision-maker (decider); consensus making among families, colleagues and society (process) and the consequential output of the decision (consequence).
conclusionsThis is the first qualitative study to demonstrate the framework of paediatricians' decision-making processes and the complex structures of dilemmas they face. Our data indicate the necessity of establishing and implementing an effective support system for paediatricians, such as structured professional education and arguments for creating social consensus that assist them to reach the best plan for the management of severely ill children.
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