ArticlePalliative medicine2021
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.
Article in Palliative medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Formulating parents' feelings: Analyzing parent-nurse conversations in family-integrated neonatal care to develop communication training.PEC innovation · 2024Article
- Varying (preferred) levels of involvement in treatment decision-making in the intensive care unit before and during the COVID-19 pandemic: a mixed-methods study among relatives.BMC medical informatics and decision making · 2024Article
- Navigating the shadows: medical professionals' values and perspectives on end-of-life care within pediatric intensive care units in Croatia.Frontiers in pediatrics · 2024Article
- Argumentation in end-of-life conversations with families in Dutch intensive care units: a qualitative observational study.Intensive care medicine · 2023Observational
- The Future of Cardiothoracic Surgical Critical Care Medicine as a Medical Science: A Call to Action.Medicina (Kaunas, Lithuania) · 2022Review
- 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 · 2022Article
- NEO-SPEAK: A conceptual framework that underpins breaking bad news in neonatology.Frontiers in pediatrics · 2022Article
Corrections and comments
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIntensive 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.
aimTo explore
designExploratory inductive thematic analysis of 101 audio-recorded conversations. SETTING/
participantsOne 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.
resultsWe 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.
conclusionsEven 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.
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