End-of-Life Care Decisions in the PICU: Roles Professionals Play

被引:58
作者
Michelson, Kelly Nicole [1 ,2 ,3 ]
Patel, Rachna
Haber-Barker, Natalie [1 ,4 ]
Emanuel, Linda [3 ,5 ]
Frader, Joel [2 ,6 ,7 ]
机构
[1] Northwestern Univ, Childrens Mem Hosp, Div Crit Care Med, Chicago, IL 60614 USA
[2] Northwestern Univ, Feinberg Sch Med, Dept Pediat, Chicago, IL 60614 USA
[3] Northwestern Univ, Buehler Ctr Aging Hlth & Soc, Chicago, IL 60614 USA
[4] Loyola Univ, Grad Sch, Chicago, IL 60611 USA
[5] Northwestern Univ, Feinberg Sch Med, Div Gen Internal Med, Chicago, IL 60614 USA
[6] Northwestern Univ, Feinberg Sch Med, Div Gen Acad Med, Chicago, IL 60614 USA
[7] Northwestern Univ, Feinberg Sch Med, Program Med Humanities & Bioeth, Chicago, IL 60614 USA
关键词
communication; decision making; end-of-life care; PICU; qualitative research; roles; CHILDS DEATH; UNIT; PARENTS; RECOMMENDATIONS; COMMUNICATION; NEEDS; MODEL; TIME;
D O I
10.1097/PCC.0b013e31826e7408
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: Describe the roles and respective responsibilities of PICU healthcare professionals in end-of-life care decisions faced by PICU parents. Design: Retrospective qualitative study. Setting: University-based tertiary care children's hospital. Participants: Eighteen parents of children who died in the pediatric ICU and 48 PICU healthcare professionals (physicians, nurses, social workers, child-life specialists, chaplains, and case managers). Interventions: In depth, semi-structured focus groups and one-on-one interviews designed to explore experiences in end-of-life care decision making. Measurements and Main Results: We identified end-of-life care decisions that parents face based on descriptions by parents and healthcare professionals. Participants described medical and nonmedical decisions addressed toward the end of a child's life. From the descriptions, we identified seven roles healthcare professionals play in end-of-life care decisions. The family supporter addresses emotional, spiritual, environmental, relational, and informational family needs in a nondirective way. The family advocate helps families articulate their views and needs to healthcare professionals. The information giver provides parents with medical information, identifies decisions or describes available options, and clarifies parents' understanding. The general care coordinator helps facilitate interactions among healthcare professionals in the PICU, among healthcare professionals from different subspecialty teams, and between healthcare professionals and parents. The decision maker makes or directly influences the defined plan of action. The end-of-life care coordinator organizes and executes functions occurring directly before, during, and after dying/death. The point person develops a unique trusting relationship with - parents. Conclusions: Our results describe a framework for healthcare professionals' roles in parental end-of-life care decision making in the pediatric ICU that includes directive, value-neutral, and organizational roles. More research is needed to validate these roles. Actively ensuring attention to these roles during the decision-making process could improve parents' experiences at the end of a child's life. (Pediatr Crit Care Med 2013; 14:e34-e44)
引用
收藏
页码:E34 / E44
页数:11
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