Professional Responsibility, Consensus, and Conflict: A Survey of Physician Decisions for the Chronically Critically Ill in Neonatal and Pediatric Intensive Care Units

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Abstract

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.

Original languageEnglish (US)
JournalPediatric Critical Care Medicine
DOIs
StateAccepted/In press - Jun 27 2017

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Pediatric Intensive Care Units
Neonatal Intensive Care Units
Critical Illness
Consensus
Chronic Disease
Physicians
Pediatrics
Decision Making
Tracheostomy
Family Physicians
Conflict (Psychology)
Surveys and Questionnaires
Therapeutics
Neonatologists
Research

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

@article{fd178ec838d642eabfa816f6e8f9ae6f,
title = "Professional Responsibility, Consensus, and Conflict: A Survey of Physician Decisions for the Chronically Critically Ill in Neonatal and Pediatric Intensive Care Units",
abstract = "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.",
author = "Shapiro, {Miriam C.} and Donohue, {Pamela Kimzey} and Kudchadkar, {Sapna R} and Nancy Hutton and Renee Boss",
year = "2017",
month = "6",
day = "27",
doi = "10.1097/PCC.0000000000001247",
language = "English (US)",
journal = "Pediatric Critical Care Medicine",
issn = "1529-7535",
publisher = "Lippincott Williams and Wilkins",

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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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