Nudging During Pediatric Intensive Care Conferences With Family Members: Retrospective Analysis of Transcripts From a...

Area of Science:

• Behavioral economics
• Clinical decision-making
• Medical ethics

Background:

• Nudging, a concept from behavioral economics, subtly influences choices without limiting options.
• While widely used, nudging's specific application in clinical shared decision-making (SDM) remains understudied.
• Understanding nudging in SDM is crucial for ethical and effective patient-centered care.

Purpose of the Study:

• To analyze the utilization of nudging techniques by clinicians during shared decision-making (SDM) in pediatric intensive care unit (PICU) family care conferences.
• To identify the types and frequency of nudges employed in these critical care discussions.

Main Methods:

• Retrospective analysis of 70 recorded family care conference transcripts from a quaternary pediatric facility (2015-2019).
• Coding of decision-making discussions for specific nudging instances (e.g., framing, default options, expert opinion).
• Categorization of nudges by decision type (e.g., tracheostomy, goals of care, procedures).

Main Results:

• Sixty-three of 70 transcripts (90%) included SDM episodes, with a median of 5 decision episodes per conference.
• A total of 1096 nudging instances were identified across all conferences.
• Gain framing (18.5%) and loss framing (13.7%) were the most prevalent nudging strategies observed.

Conclusions:

• Nudging is a common practice among clinicians in PICU care conferences, primarily utilizing framing techniques.
• This analysis provides valuable insights into the application, potential benefits, and risks of nudging in SDM.
• Findings can inform future curriculum development for healthcare trainees on ethical decision-making support.