Discussing Benefits and Risks of Tracheostomy: What Physicians Actually Say.

Area of Science:

• Pediatric critical care medicine
• Medical communication
• Patient decision-making

Background:

• Family-physician conferences are crucial for discussing tracheostomy placement in children.
• Disclosure of procedure risks and benefits is a key component of these discussions.

Purpose of the Study:

• To compare the benefits and risks of tracheostomy discussed in family-physician conferences with expert panel recommendations.
• To assess the balance of risk and benefit disclosure during pediatric tracheostomy consultations.

Main Methods:

• Retrospective review of 19 audio-recorded family-physician conferences for pediatric tracheostomy placement.
• Survey of a multidisciplinary expert panel to establish recommended risks and benefits.
• Qualitative analysis of physician statements during conferences.

Main Results:

• Physicians discussed benefits more frequently (72%) than risks (28%) of tracheostomy.
• Identified benefits included limiting PICU impact, overcoming obstacles, and optimizing respiratory health.
• Identified risks focused on commitment and potential complications.

Conclusions:

• Physicians tend to emphasize tracheostomy benefits, potentially minimizing risks discussed with families.
• Expert panel recommended a balanced presentation of both risks and benefits.
• Enhanced disclosure of a wider range of risks and benefits is needed for informed pediatric tracheostomy decision-making.