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How Physicians Discuss Uncertainty With Parents in Intensive Care Units.

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Title: How Physicians Discuss Uncertainty With Parents in Intensive Care Units.
Authors: Prins, Sanne, Linn, Annemiek J., van Kaam, Anton H. L. C., van de Loo, Moniek, van Woensel, Job B. M., van Heerde, Marc, Dijk, Peter H., Kneyber, Martin C. J., de Hoog, Matthijs, Simons, Sinno H. P., Akkermans, Aranka A., Smets, Ellen M. A., Hillen, Marij A., de Vos, Mirjam A.
Source: Pediatrics. Jun2022, Vol. 149 Issue 6, p1-10. 11p.
Subjects: Intensive care units, Neonatal intensive care, Academic medical centers, Physician-patient relations, Conversation, Critically ill, Uncertainty, Neonatal intensive care units, Pediatrics, Patients, Qualitative research, Physicians, Data analysis software
Abstract: BACKGROUND AND OBJECTIVES: Physicians and parents of critically ill neonates and children receiving intensive care have to make decisions on the child's behalf. Throughout the child's illness and treatment trajectory, adequately discussing uncertainties with parents is pivotal because this enhances the quality of the decision-making process and may positively affect the child's and parents' well-being. We investigated how physicians discuss uncertainty with parents and how this discussion evolves over time during the trajectory. METHODS: We asked physicians working in the NICU and PICU of 3 university medical centers to audio record their conversations with parents of critically ill children from the moment doubts arose whether treatment was in the child's best interests. We qualitatively coded and analyzed the anonymized transcripts, thereby using the software tool MAXQDA 2020. RESULTS: Physicians were found to adapt the way they discussed uncertainty with parents to the specific phase of the child's illness and treatment trajectory. When treatment options were still available, physicians primarily focused on uncertainty related to diagnostic procedures, treatment options, and associated risks and effects. Particularly when the child's death was imminent, physicians had less "scientific" guidance to offer. They eliminated most uncertainty and primarily addressed practical uncertainties regarding the child's dying process to offer parents guidance. CONCLUSIONS: Our insights may increase physicians' awareness and enhance their skills in discussing uncertainties with parents tailored to the phase of the child's illness and treatment trajectory and to parental needs in each specific phase. [ABSTRACT FROM AUTHOR]
Copyright of Pediatrics is the property of American Academy of Pediatrics and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: How Physicians Discuss Uncertainty With Parents in Intensive Care Units.
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  Data: <searchLink fieldCode="AR" term="%22Prins%2C+Sanne%22">Prins, Sanne</searchLink><br /><searchLink fieldCode="AR" term="%22Linn%2C+Annemiek+J%2E%22">Linn, Annemiek J.</searchLink><br /><searchLink fieldCode="AR" term="%22van+Kaam%2C+Anton+H%2E+L%2E+C%2E%22">van Kaam, Anton H. L. C.</searchLink><br /><searchLink fieldCode="AR" term="%22van+de+Loo%2C+Moniek%22">van de Loo, Moniek</searchLink><br /><searchLink fieldCode="AR" term="%22van+Woensel%2C+Job+B%2E+M%2E%22">van Woensel, Job B. M.</searchLink><br /><searchLink fieldCode="AR" term="%22van+Heerde%2C+Marc%22">van Heerde, Marc</searchLink><br /><searchLink fieldCode="AR" term="%22Dijk%2C+Peter+H%2E%22">Dijk, Peter H.</searchLink><br /><searchLink fieldCode="AR" term="%22Kneyber%2C+Martin+C%2E+J%2E%22">Kneyber, Martin C. J.</searchLink><br /><searchLink fieldCode="AR" term="%22de+Hoog%2C+Matthijs%22">de Hoog, Matthijs</searchLink><br /><searchLink fieldCode="AR" term="%22Simons%2C+Sinno+H%2E+P%2E%22">Simons, Sinno H. P.</searchLink><br /><searchLink fieldCode="AR" term="%22Akkermans%2C+Aranka+A%2E%22">Akkermans, Aranka A.</searchLink><br /><searchLink fieldCode="AR" term="%22Smets%2C+Ellen+M%2E+A%2E%22">Smets, Ellen M. A.</searchLink><br /><searchLink fieldCode="AR" term="%22Hillen%2C+Marij+A%2E%22">Hillen, Marij A.</searchLink><br /><searchLink fieldCode="AR" term="%22de+Vos%2C+Mirjam+A%2E%22">de Vos, Mirjam A.</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Pediatrics%22">Pediatrics</searchLink>. Jun2022, Vol. 149 Issue 6, p1-10. 11p.
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– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: BACKGROUND AND OBJECTIVES: Physicians and parents of critically ill neonates and children receiving intensive care have to make decisions on the child's behalf. Throughout the child's illness and treatment trajectory, adequately discussing uncertainties with parents is pivotal because this enhances the quality of the decision-making process and may positively affect the child's and parents' well-being. We investigated how physicians discuss uncertainty with parents and how this discussion evolves over time during the trajectory. METHODS: We asked physicians working in the NICU and PICU of 3 university medical centers to audio record their conversations with parents of critically ill children from the moment doubts arose whether treatment was in the child's best interests. We qualitatively coded and analyzed the anonymized transcripts, thereby using the software tool MAXQDA 2020. RESULTS: Physicians were found to adapt the way they discussed uncertainty with parents to the specific phase of the child's illness and treatment trajectory. When treatment options were still available, physicians primarily focused on uncertainty related to diagnostic procedures, treatment options, and associated risks and effects. Particularly when the child's death was imminent, physicians had less "scientific" guidance to offer. They eliminated most uncertainty and primarily addressed practical uncertainties regarding the child's dying process to offer parents guidance. CONCLUSIONS: Our insights may increase physicians' awareness and enhance their skills in discussing uncertainties with parents tailored to the phase of the child's illness and treatment trajectory and to parental needs in each specific phase. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of Pediatrics is the property of American Academy of Pediatrics and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=157963558
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    Identifiers:
      – Type: doi
        Value: 10.1542/peds.2021-055980
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        Text: English
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      – SubjectFull: Intensive care units
        Type: general
      – SubjectFull: Neonatal intensive care
        Type: general
      – SubjectFull: Academic medical centers
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      – SubjectFull: Physician-patient relations
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      – SubjectFull: Uncertainty
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      – SubjectFull: Pediatrics
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      – SubjectFull: Qualitative research
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      – SubjectFull: Physicians
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      – SubjectFull: Data analysis software
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