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How Clinician-Family Interactions Potentially Impact Clinicians' Conceptualization and Discussions Regarding
Hayley A Peoples1, Blair Boone2, Jennifer S Blumenthal-Barby1
1Department of Orthopaedic Surgery and Scoliosis, Clinical Care Center, Baylor College of Medicine, Center for Medical Ethics & Health Policy, Texas Children's Hospital, Houston, TX, USA.
Objectives:
Little is known about how clinicians perceive prognostic uncertainty. Our study objective was to identify factors that influence how prognostic uncertainty is viewed by physicians, as it relates to their communications with families.
Design:
Thirty semi-structured interviews with qualitative content analysis (9 surgeons, 16 intensivists, 3 nurse practitioners, and 2 "other" clinicians). We analyzed interviews using qualitative description with constant comparative techniques.
Setting:
Open medical, surgical, neurosurgical, and cardiovascular intensive care units (ICUs) in a 900-bed academic, tertiary Houston hospital.
Interventions:
None.
Main Results:
We identified 2 main factors that influence how clinicians perceive prognostic uncertainty and their perceptions about whether and why they communicate prognostic uncertainties to families: (1) Communicating Uncertainty to "Soften the Blow"; and (2) Communicating Uncertainty in Response to Clinicians' Interpretations of Surrogate Decision Makers' Perceptions of Prognostic Uncertainty. We also identified several subthemes.
Conclusions:
Clinician-family interactions influence how clinicians perceive prognostic uncertainty in their communications with patients or families. We discuss ethical and clinical implications of our findings.