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Shared decision-making in pediatric intensive care units: a qualitative study with physicians, nurses and parents
Rabia Kahveci1, Duygu Ayhan, Pınar Döner
1Department of Family Medicine, Ankara Numune Training and Research Hospital, Talatpasa Bulvari No: 5, Altindag, 06100, Ankara, Turkey.
Insights
In Turkish Intensive Care Units (ICUs), doctors are seen as the primary decision-makers for life-support, with nurses and parents preferring physicians to lead these critical choices.
Area of Science:
- Pediatric Critical Care Medicine
- Medical Ethics
- Health Psychology
Background:
- Life-support decisions in Intensive Care Units (ICUs) for critically ill children are complex.
- Understanding the perceptions of healthcare professionals and parents is crucial for effective decision-making processes.
Purpose of the Study:
- To investigate decision-making processes in pediatric Intensive Care Units (ICUs).
- To explore the perceptions of doctors, nurses, and parents regarding life-support decisions.
- To assess the understanding and practice of shared decision-making in this context.
Main Methods:
- Qualitative study employing in-depth, semi-structured, face-to-face interviews.
- Participants included 8 doctors, 9 nurses, and 6 parents of critically ill children.
- Interview transcriptions were analyzed using open coding and thematic analysis.
Main Results:
- A central theme identified was the perceived roles and emotions during decision-making.
- Doctors, nurses, and parents predominantly viewed physicians as the primary decision-makers.
- Nurses reported closer relationships with parents and better understanding of parental emotions.
Conclusions:
- Shared decision-making is not well understood or implemented by healthcare professionals in Turkey.
- Physicians are perceived as the main authority in life-support decisions, a role accepted by parents and nurses.
- Parents' fear of making incorrect decisions contributes to their preference for physician-led choices.
Objectives:
To understand how decisions are made in Intensive Care Unit (ICU) settings where critically-ill children require life-support decisions and what are the perceptions of health professionals and parents.
Methods:
In this qualitative study, in-depth, semi-structured, face to face interviews with 8 doctors, 9 nurses and 6 parents of critically ill children were conducted. Interviews were digitally recorded and transcribed. The transcriptions were further analyzed following open coding and formation of themes.
Results:
The themes were discussed in two major titles: perceived roles and emotions during the decision-making process. All nurses and patients agreed that the decision maker should be the physician. Nurses understood patients' emotions better and had a closer relation with the parents. Both doctors and nurses thought that parents could not have all responsibilities about treatment choices, because they do not have the required knowledge. Similarly parents were afraid to make a wrong decision, thus they wanted to leave this to the doctors.
Conclusions:
The present study revealed that shared-decision making is not well understood by health care professionals in Turkey. Doctor is the major decision-making authority and this is also accepted and preferred by the patients and nurses.
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