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A Descriptive Study of Decision-Making Conversations during Pediatric Intensive Care Unit Family Conferences
Michael A Smith1, Marla L Clayman2, Joel Frader3,4
11 Department of Pediatrics, University of California San Francisco , San Francisco, California.
Insights
Decision-making in pediatric intensive care unit (PICU) family conferences is a nonlinear process. Key shared decision-making (SDM) elements were often missing, indicating opportunities to improve family-centered care during critical illness.
Area of Science:
- Pediatric Critical Care Medicine
- Health Communication
- Shared Decision Making
Background:
- Decision-making conversations during pediatric intensive care unit (PICU) family conferences (FCs) are not well understood.
- Effective communication is crucial for family-centered care in high-stakes environments.
Purpose of the Study:
- To describe the decision-making process during PICU family conferences.
- To evaluate the implementation of shared decision making (SDM) within these conferences.
Main Methods:
- An observational study analyzed 14 recorded and transcribed PICU family conferences.
- A modified grounded theory and content analysis approach examined decision-making stages and SDM elements.
Main Results:
- Decision-making (DM) progressed through nonlinear stages: information exchange, deliberation, and planning.
- While clinical issues and alternatives were presented, key SDM elements like assessing family understanding (21%) and eliciting opinions (42%) were infrequent.
Conclusions:
- PICU family conferences involve a nonlinear decision-making process.
- Gaps in SDM elements suggest areas for improving parent involvement and communication in PICU care.
Background:
Little is known about how decision-making conversations occur during pediatric intensive care unit (PICU) family conferences (FCs).
Objective:
Describe the decision-making process and implementation of shared decision making (SDM) during PICU FCs.
Design:
Observational study.
Setting/Subjects:
University-based tertiary care PICU, including 31 parents and 94 PICU healthcare professionals involved in FCs.
Measurements:
We recorded, transcribed, and analyzed 14 PICU FCs involving decision-making discussions. We used a modified grounded theory and content analysis approach to explore the use of traditionally described stages of decision making (DM) (information exchange, deliberation, and determining a plan). We also identified the presence or absence of predefined SDM elements.
Results:
DM involved the following modified stages: information exchange; information-oriented deliberation; plan-oriented deliberation; and determining a plan. Conversations progressed through stages in a nonlinear manner. For the main decision discussed, all conferences included a presentation of the clinical issues, treatment alternatives, and uncertainty. A minority of FCs included assessing the family's understanding (21%), assessing the family's need for input from others (28%), exploring the family's desired decision-making role (35%), and eliciting the family's opinion (42%).
Conclusions:
In the FCs studied, we found that DM is a nonlinear process. We also found that several SDM elements that could provide information about parents' perspectives and needs did not always occur, identifying areas for process improvement.
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