TY - JOUR
T1 - A Descriptive Study of Decision-Making Conversations during Pediatric Intensive Care Unit Family Conferences
AU - Smith, Michael A.
AU - Clayman, Marla L.
AU - Frader, Joel
AU - Arenson, Melanie
AU - Haber-Barker, Natalie
AU - Ryan, Claire
AU - Emanuel, Linda
AU - Michelson, Kelly
N1 - Funding Information:
This work was supported by a grant from The National Palliative Care Research Center (NPCRC) entitled, ‘‘Evaluating Family Conferences in the Pediatric Intensive Care Unit.’’
Publisher Copyright:
© 2018, Mary Ann Liebert, Inc., publishers.
PY - 2018/9
Y1 - 2018/9
N2 - Background: Little is known about how decision-making conversations occur during pediatric intensive care unit (PICU) family conferences (FCs). Objective: Describe the decision-making process and implementation of shared decision making (SDM) during PICU FCs. Design: Observational study. Setting/Subjects: University-based tertiary care PICU, including 31 parents and 94 PICU healthcare professionals involved in FCs. Measurements: We recorded, transcribed, and analyzed 14 PICU FCs involving decision-making discussions. We used a modified grounded theory and content analysis approach to explore the use of traditionally described stages of decision making (DM) (information exchange, deliberation, and determining a plan). We also identified the presence or absence of predefined SDM elements. Results: DM involved the following modified stages: information exchange; information-oriented deliberation; plan-oriented deliberation; and determining a plan. Conversations progressed through stages in a nonlinear manner. For the main decision discussed, all conferences included a presentation of the clinical issues, treatment alternatives, and uncertainty. A minority of FCs included assessing the family's understanding (21%), assessing the family's need for input from others (28%), exploring the family's desired decision-making role (35%), and eliciting the family's opinion (42%). Conclusions: In the FCs studied, we found that DM is a nonlinear process. We also found that several SDM elements that could provide information about parents' perspectives and needs did not always occur, identifying areas for process improvement.
AB - Background: Little is known about how decision-making conversations occur during pediatric intensive care unit (PICU) family conferences (FCs). Objective: Describe the decision-making process and implementation of shared decision making (SDM) during PICU FCs. Design: Observational study. Setting/Subjects: University-based tertiary care PICU, including 31 parents and 94 PICU healthcare professionals involved in FCs. Measurements: We recorded, transcribed, and analyzed 14 PICU FCs involving decision-making discussions. We used a modified grounded theory and content analysis approach to explore the use of traditionally described stages of decision making (DM) (information exchange, deliberation, and determining a plan). We also identified the presence or absence of predefined SDM elements. Results: DM involved the following modified stages: information exchange; information-oriented deliberation; plan-oriented deliberation; and determining a plan. Conversations progressed through stages in a nonlinear manner. For the main decision discussed, all conferences included a presentation of the clinical issues, treatment alternatives, and uncertainty. A minority of FCs included assessing the family's understanding (21%), assessing the family's need for input from others (28%), exploring the family's desired decision-making role (35%), and eliciting the family's opinion (42%). Conclusions: In the FCs studied, we found that DM is a nonlinear process. We also found that several SDM elements that could provide information about parents' perspectives and needs did not always occur, identifying areas for process improvement.
KW - communication
KW - decision making
KW - family conferences
KW - pediatric intensive care
KW - pediatrics
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U2 - 10.1089/jpm.2017.0528
DO - 10.1089/jpm.2017.0528
M3 - Article
C2 - 29920145
AN - SCOPUS:85053330130
VL - 21
SP - 1290
EP - 1299
JO - Journal of Palliative Medicine
JF - Journal of Palliative Medicine
SN - 1096-6218
IS - 9
ER -