Parental involvement in neonatal critical care decision-making

Area of Science:

• Medical Communication
• Neonatal Intensive Care
• Palliative Care Decision-Making

Background:

• Neonatal intensive care units (NICUs) present complex ethical and communication challenges.
• Decisions regarding redirection of care from intensive to palliative care are particularly sensitive.
• Effective communication is crucial for shared decision-making between clinicians and families.

Purpose of the Study:

• To analyze communication strategies used by doctors during end-of-life care discussions with parents in the NICU.
• To examine how different communication approaches impact parental involvement and decision-making alignment.
• To identify implications for medical communication training and clinical guidance.

Main Methods:

• Qualitative analysis of recorded formal interactions between doctors and 31 families in an English NICU.
• Utilized conversation analysis to examine decision-making sequences regarding care redirection.
• Focused on two distinct doctor communication approaches: 'making recommendations' and 'providing options'.

Main Results:

• The 'making recommendations' approach resulted in misalignment and limited parental collaboration.
• 'Providing options' fostered alignment, encouraged questions, and facilitated fuller parental participation.
• Communication strategies significantly influenced the trajectory of parental involvement in end-of-life decisions.

Conclusions:

• Doctor communication style critically impacts shared decision-making in neonatal palliative care.
• The 'providing options' approach is associated with more collaborative and aligned decision-making processes.
• Findings underscore the need for enhanced medical communication training for sensitive end-of-life discussions.