Professional Responsibility, Consensus, and Conflict: A Survey of Physician Decisions for the Chronically Critically Ill in Neonatal and Pediatric Intensive Care Units.
Pediatr Crit Care Med
; 18(9): e415-e422, 2017 Sep.
Article
em En
| MEDLINE
| ID: mdl-28658198
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 MAINRESULTS:
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.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Responsabilidade Social
/
Padrões de Prática Médica
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Atitude do Pessoal de Saúde
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Cuidados Críticos
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Consenso
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Dissidências e Disputas
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Tomada de Decisão Clínica
Tipo de estudo:
Guideline
/
Prognostic_studies
Limite:
Adolescent
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Child
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Child, preschool
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Female
/
Humans
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Infant
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Male
/
Newborn
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article