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Factors influencing pediatric interns' relationships with dying children and their parents
Insights
Physician relationships with dying children and their families are influenced by patient age, neurologic status, and illness duration. Understanding these factors helps senior staff support interns, preventing over-involvement or distancing.
Area of Science:
- Pediatric Medicine
- Medical Education
- Psychology
Background:
- Caring for terminally ill children presents unique challenges for physicians.
- House officers require specific support to navigate complex emotional situations.
Purpose of the Study:
- To investigate factors influencing house officers' relationships with dying children and their parents.
- To identify how to best support new physicians in pediatric end-of-life care.
Main Methods:
- Conducted open-ended interviews with interns and residents within 36 hours of a child's death.
- Interviewed staff involved in the care of 31 hospitalized children who died.
Main Results:
- Intern relationships with fatally ill children were affected by the child's age and neurologic status.
- Relationships with parents were influenced by attitudes toward the child and illness duration, especially in comatose patients.
- Illness duration and patient responsiveness were key factors impacting physician-parent interactions.
Conclusions:
- Senior medical staff awareness of patient factors (age, responsiveness, duration) is crucial for providing targeted support.
- Appropriate support can prevent detrimental physician distancing or over-involvement.
- This support enhances the ability of physicians to provide optimal emotional care to patients, families, and themselves.
Abstract:
Events and feelings immediately surrounding the deaths of children in the hospital were investigated in order to identify factors that might influence a house officer's ability to relate in a personally satisfying way to dying children and their parents. Open-ended interviews with the involved interns and their supervising residents were conducted within 36 hours of the deaths of 31 hospitalized children to gain insight into the reactions and responses of new physicians managing terminally ill patients. Interns' relationships with children who were fatally ill appeared to be influenced by two factors: the child's age and the child's neurologic status. The interns' relationships with parents reflected their attitudes toward the children but were also affected by the duration of the illness, especially in instances when the patients were comatose or severely impaired. Senior medical staff awareness of the age and responsiveness of dying patients and the duration of their illness can help to provide case-specific guidance and support to the interns. Such support may help prevent that excessive distancing or over involvement that can impair the interns' abilities to provide optimal emotional support to patients, the families, or themselves.