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Assessment of physician directiveness: using hypoplastic left heart syndrome as a model
1Section of Pediatric Critical Care Medicine and the Program in Bioethics at the University of California Davis, Davis, CA 95817, USA.
Insights
Surgeons and cardiologists are more directive than neonatologists when discussing care for critically ill children. Physician specialty impacts directiveness, but parental preference for direction remains unknown.
Area of Science:
- Pediatric Critical Care Medicine
- Congenital Heart Surgery
- Medical Communication
Background:
- Physician communication styles vary significantly.
- Understanding directiveness in pediatric critical care is crucial for family-centered care.
- Hypoplastic left heart syndrome (HLHS) requires complex decision-making between families and medical teams.
Purpose of the Study:
- To investigate differences in physician directiveness among specialists treating critically ill children.
- To test the hypothesis that surgeons are more directive than pediatricians.
Main Methods:
- A novel directiveness assessment tool was developed and administered via survey.
- Physicians from Neonatology, Pediatric Critical Care, Pediatric Cardiology, and Congenital Cardiac Surgery at major US centers participated.
- Univariate and multivariable linear regression analyses were used to evaluate associations between physician specialty and directiveness scores.
Main Results:
- 138 physician responses were analyzed.
- Surgeons exhibited the highest directiveness scores compared to neonatologists (P=0.01).
- Cardiologists also showed significantly higher directiveness than neonatologists (P=0.03).
Conclusions:
- Physician specialty is a significant factor associated with directiveness in discussions with parents of critically ill children.
- Further research is needed to ascertain parental preferences regarding physician directiveness.
- This study highlights potential communication style variations among pediatric subspecialists involved in HLHS care.
Objective:
To test the hypothesis that surgeons are more directive than pediatricians in discussions with parents of critically ill children.
Study Design:
We designed a novel tool to assess physician directiveness in discussions with parents of children with hypoplastic left heart syndrome. We sent surveys containing the assessment tool as well as demographic questions to all attending physicians in Neonatology, Pediatric Critical Care, Pediatric Cardiology, and Congenital Cardiac Surgery at 14 of the largest pediatric cardiac surgery centers in the United States. Responses to the tool were used to determine a "directiveness score" for each physician. We then performed univariate and multivariable linear regression analyses to assess the association of physician specialty, race/ethnicity, religion, gender, and years in practice with the directiveness score.
Results:
Responses from 138 physicians were analyzed. In univariate analyses, with neonatologists as the reference group, surgeons were most directive (regression coefficient 3.02, 95% confidence interval 0.69 to 5.35, P=0.01), followed by cardiologists (regression coefficient 1.67, 95% confidence interval 0.13 to 3.20, P=0.03). No other variable was associated with physician directiveness score. These results were similar in the multivariable analysis.
Conclusions:
These results suggest that physician specialty is associated with directiveness. It is unclear, however, what amount of direction parents of critically ill children prefer.
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