Initiating end-of-life decisions with parents of infants receiving neonatal intensive care

Title

Initiating end-of-life decisions with parents of infants receiving neonatal intensive care

Creator

Shaw C; Connabeer K; Drew P; Gallagher K; Aladangady N; Marlow N

Publisher

Patient Education and Counseling

Date

2020

Subject

Conversation analysis; Decision making; End-of-life; interest. NM declares personal fees for consultancy from Shire and Novartis; Neonates; outside the submitted work.; Parents; Withdrawing; Withholding

Description

OBJECTIVE: To investigate whether parent-initiated or doctor-initiated decisions about limiting life-sustaining treatment (LST) in neonatal care has consequences for how possible courses of action are presented. METHOD: Formal conversations (n = 27) between doctors and parents of critically ill babies from two level 3 neonatal intensive care units were audio or video recorded. Sequences of talk where decisions about limiting LST were presented were analysed using Conversation Analysis and coded using a Conversation Analytic informed coding framework. Relationships between codes were analysed using Fisher's exact test. RESULTS: When parents initiated the decision point, doctors subsequently tended to refer to or list available options. When doctors initiated, they tended to use 'recommendations' or 'single-option' choice (conditional) formats (p=0.017) that did not include multiple treatment options. Parent initiations overwhelmingly concerned withdrawal, as opposed to withholding of LST (p=0.030). CONCLUSION: Aligning parents to the trajectory of the news about their baby's poor condition may influence how the doctor subsequently presents the decision to limit LST, and thereby the extent to which parents are invited to participate in shared decision-making. PRACTICE IMPLICATIONS: Explicitly proposing treatment options may provide parents with opportunities to be involved in decisions for their critically ill babies, thereby fostering shared decision-making.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Citation List Month

April 2020 List

Collection

Citation

Shaw C; Connabeer K; Drew P; Gallagher K; Aladangady N; Marlow N, “Initiating end-of-life decisions with parents of infants receiving neonatal intensive care,” Pediatric Palliative Care Library, accessed December 7, 2021, https://pedpalascnetlibrary.omeka.net/items/show/17043.

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