A Descriptive Study of Decision-Making Conversations during Pediatric Intensive Care Unit Family Conferences

Michael A. Smith*, Marla L. Clayman, Joel Frader, Melanie Arenson, Natalie Haber-Barker, Claire Ryan, Linda Emanuel, Kelly Michelson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1290-1299
Number of pages10
JournalJournal of palliative medicine
Issue number9
StatePublished - Sep 2018


  • communication
  • decision making
  • family conferences
  • pediatric intensive care
  • pediatrics

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • General Nursing


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