TY - JOUR
T1 - Professional Responsibility, Consensus, and Conflict
T2 - A Survey of Physician Decisions for the Chronically Critically Ill in Neonatal and Pediatric Intensive Care Units
AU - Shapiro, Miriam C.
AU - Donohue, Pamela Kimzey
AU - Kudchadkar, Sapna R
AU - Hutton, Nancy
AU - Boss, Renee
PY - 2017/6/27
Y1 - 2017/6/27
N2 - OBJECTIVE:: To describe neonatologist and pediatric intensivist attitudes and practices relevant to high-stakes decisions for children with chronic critical illness, with particular attention to physician perception of professional duty to seek treatment team consensus and to disclose team conflict. DESIGN:: Self-administered online survey. SETTING:: U.S. neonatal ICUs and PICUs. SUBJECTS:: Neonatologists and pediatric intensivists. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: We received 652 responses (333 neonatologists, denominator unknown; 319 of 1,290 pediatric intensivists). When asked about guiding a decision for tracheostomy in a chronically critically ill infant, only 41.7% of physicians indicated professional responsibility to seek a consensus decision, but 73.3% reported, in practice, that they would seek consensus and make a consensus-based recommendation; the second most common practice (15.5%) was to defer to families without making recommendations. When presented with conflict among the treatment team, 63% of physicians indicated a responsibility to be transparent about the decision-making process and reported matching practices. Neonatologists more frequently reported a responsibility to give decision making fully over to families; intensivists were more likely to seek out consensus among the treatment team. CONCLUSIONS:: ICU physicians do not agree about their responsibilities when approaching difficult decisions for chronically critically ill children. Although most physicians feel a professional responsibility to provide personal recommendations or defer to families, most physicians report offering consensus recommendations. Nearly all physicians embrace a sense of responsibility to disclose disagreement to families. More research is needed to understand physician responsibilities for making recommendations in the care of chronically critically ill children.
AB - OBJECTIVE:: To describe neonatologist and pediatric intensivist attitudes and practices relevant to high-stakes decisions for children with chronic critical illness, with particular attention to physician perception of professional duty to seek treatment team consensus and to disclose team conflict. DESIGN:: Self-administered online survey. SETTING:: U.S. neonatal ICUs and PICUs. SUBJECTS:: Neonatologists and pediatric intensivists. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: We received 652 responses (333 neonatologists, denominator unknown; 319 of 1,290 pediatric intensivists). When asked about guiding a decision for tracheostomy in a chronically critically ill infant, only 41.7% of physicians indicated professional responsibility to seek a consensus decision, but 73.3% reported, in practice, that they would seek consensus and make a consensus-based recommendation; the second most common practice (15.5%) was to defer to families without making recommendations. When presented with conflict among the treatment team, 63% of physicians indicated a responsibility to be transparent about the decision-making process and reported matching practices. Neonatologists more frequently reported a responsibility to give decision making fully over to families; intensivists were more likely to seek out consensus among the treatment team. CONCLUSIONS:: ICU physicians do not agree about their responsibilities when approaching difficult decisions for chronically critically ill children. Although most physicians feel a professional responsibility to provide personal recommendations or defer to families, most physicians report offering consensus recommendations. Nearly all physicians embrace a sense of responsibility to disclose disagreement to families. More research is needed to understand physician responsibilities for making recommendations in the care of chronically critically ill children.
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U2 - 10.1097/PCC.0000000000001247
DO - 10.1097/PCC.0000000000001247
M3 - Article
C2 - 28658198
AN - SCOPUS:85021426238
SN - 1529-7535
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
ER -