Abstract
Background:
Intensive care doctors have to find the right balance between sharing crucial decisions with families of patients on the one hand and not overburdening them on the other hand. This requires a tailored approach instead of a model based approach.
Aim:
To explore how doctors involve families in the decision-making process regarding life-sustaining treatment on the neonatal, pediatric, and adult intensive care.
Design:
Exploratory inductive thematic analysis of 101 audio-recorded conversations.
Setting/participants:
One hundred four family members (61% female, 39% male) and 71 doctors (60% female, 40% male) of 36 patients (53% female, 47% male) from the neonatal, pediatric, and adult intensive care of a large university medical center participated.
Results:
We identified eight relevant and distinct communicative behaviors. Doctors’ sequential communicative behaviors either reflected consistent approaches—a shared approach or a physician-driven approach—or reflected vacillating between both approaches. Doctors more often displayed a physician-driven or a vacillating approach than a shared approach, especially in the adult intensive care. Doctors did not verify whether their chosen approach matched the families’ decision-making preferences.
Conclusions:
Even though tailoring doctors’ communication to families’ preferences is advocated, it does not seem to be integrated into actual practice. To allow for true tailoring, doctors’ awareness regarding the impact of their communicative behaviors is key. Educational initiatives should focus especially on improving doctors’ skills in tactfully exploring families’ decision-making preferences and in mutually sharing knowledge, values, and treatment preferences.
Intensive care doctors have to find the right balance between sharing crucial decisions with families of patients on the one hand and not overburdening them on the other hand. This requires a tailored approach instead of a model based approach.
Aim:
To explore how doctors involve families in the decision-making process regarding life-sustaining treatment on the neonatal, pediatric, and adult intensive care.
Design:
Exploratory inductive thematic analysis of 101 audio-recorded conversations.
Setting/participants:
One hundred four family members (61% female, 39% male) and 71 doctors (60% female, 40% male) of 36 patients (53% female, 47% male) from the neonatal, pediatric, and adult intensive care of a large university medical center participated.
Results:
We identified eight relevant and distinct communicative behaviors. Doctors’ sequential communicative behaviors either reflected consistent approaches—a shared approach or a physician-driven approach—or reflected vacillating between both approaches. Doctors more often displayed a physician-driven or a vacillating approach than a shared approach, especially in the adult intensive care. Doctors did not verify whether their chosen approach matched the families’ decision-making preferences.
Conclusions:
Even though tailoring doctors’ communication to families’ preferences is advocated, it does not seem to be integrated into actual practice. To allow for true tailoring, doctors’ awareness regarding the impact of their communicative behaviors is key. Educational initiatives should focus especially on improving doctors’ skills in tactfully exploring families’ decision-making preferences and in mutually sharing knowledge, values, and treatment preferences.
| Original language | English |
|---|---|
| Pages (from-to) | 1865–1877 |
| Number of pages | 13 |
| Journal | Palliative Medicine |
| Volume | 35 |
| Issue number | 10 |
| Early online date | 28 Jun 2021 |
| DOIs | |
| Publication status | Published - 1 Dec 2021 |
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study is part of the research project ‘FamICom’, which was supported by ZonMw [project number 844001316]. ZonMw is the Dutch organization for healthcare research and innovation.
| Funders | Funder number |
|---|---|
| ZonMw | 844001316 |