Shaw-etal2020
| Shaw-etal2020 | |
|---|---|
| BibType | ARTICLE |
| Key | Shaw-etal2020 |
| Author(s) | Chloe Shaw, Kathrina Connabeer, Paul Drew, Katie Gallagher, Narendra Aladangady, Neil Marlow |
| Title | Initiating end-of-life decisions with parents of infants receiving neonatal intensive care |
| Editor(s) | |
| Tag(s) | EMCA, Neonatal, Decision making, Doctor patient interaction, End of life, Parents, Withdrawing, Withholding |
| Publisher | |
| Year | 2020 |
| Language | English |
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| Month | |
| Journal | Patient Education and Counseling |
| Volume | 103 |
| Number | 7 |
| Pages | 1351–1357 |
| URL | Link |
| DOI | 10.1016/j.pec.2020.02.013 |
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Abstract
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 wereanalysed 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 mayinfluence 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.
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