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Discussing Benefits and Risks of Tracheostomy: What Physicians Actually Say
Lauren M Hebert1,2, Anne C Watson3, Vanessa Madrigal3,4
1Division of Pediatric Critical Care Medicine, Children's Hospital at Memorial University Medical Center, Savannah, GA.
Insights
Physicians often highlight tracheostomy benefits over risks during pediatric patient conferences. An expert panel recommends a balanced discussion of both benefits and risks to ensure informed family decisions.
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.
Objectives:
When contemplating tracheostomy placement in a pediatric patient, a family-physician conference is often the setting for the disclosure of risks and benefits of the procedure. Our objective was to compare benefits and risks of tracheostomy presented during family-physician conferences to an expert panel's recommendations for what should be presented.
Design:
We conducted a retrospective review of 19 transcripts of audio-recorded family-physician conferences regarding tracheostomy placement in children. A multicenter, multidisciplinary expert panel of clinicians was surveyed to generate a list of recommended benefits and risks for comparison. Primary analysis of statements by clinicians was qualitative.
Setting:
Single-center PICU of a tertiary medical center.
Subjects:
Family members who participated in family-physician conferences regarding tracheostomy placement for a critically ill child from April 2012 to August 2014.
Measurements And Main Results:
We identified 300 physician statements describing benefits and risks of tracheostomy. Physicians were more likely to discuss benefits than risks (72% vs 28%). Three broad categories of benefits were identified: 1) tracheostomy would limit the impact of being in the PICU (46%); 2) perceived obstacles of tracheostomy can be overcome (34%); and 3) tracheostomy optimizes respiratory health (20%). Risks fell into two categories: tracheostomy involves a big commitment (71%), and it has complications (29%). The expert panel's recommendations were similar to risks and benefits discussed during family conferences; however, they suggested physicians present an equal balance of discussion of risks and benefits.
Conclusions:
When discussing tracheostomy placement, physicians emphasized benefits that are shared by physicians and families while minimizing the risks. The expert panel recommended a balanced approach by equally weighing risks and benefits. To facilitate educated decision making, physicians should present a more extensive range of risks and benefits to families making this critical decision.
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