Family factors affect clinician attitudes in pediatric end-of-life decision making: a randomized vignette study.

TitleFamily factors affect clinician attitudes in pediatric end-of-life decision making: a randomized vignette study.
Publication TypeJournal Article
Year of Publication2013
AuthorsRuppe MD, Feudtner C, Hexem KR, Morrison WE
JournalJ Pain Symptom Manage
Volume45
Issue5
Pagination832-40
Date Published2013 May
ISSN1873-6513
KeywordsAdult, Advance Care Planning, Attitude of Health Personnel, Attitude to Health, Decision Making, Family Characteristics, Female, Humans, Legal Guardians, Male, Middle Aged, Pediatrics, Physicians, Religion, Surveys and Questionnaires, Terminal Care, Terminally Ill, United States, Withholding Treatment
Abstract

CONTEXT: Conflicts between families and clinicians in pediatric end-of-life (EOL) care cause distress for providers, dissatisfaction for patients' families, and potential suffering for terminally ill children.

OBJECTIVES: We hypothesized that family factors might influence clinician decision making in these circumstances.

METHODS: We presented vignettes concerning difficult EOL decision making, randomized for religious objection to therapy withdrawal and perceived level of family involvement, to clinicians working in three Children's Hospital intensive care units. Additionally, attitudes about EOL care were assessed.

RESULTS: Three hundred sixty-four respondents completed the questionnaire, for an overall response rate of 54%. Respondents receiving the "involved family" vignette were more likely to agree to continue medical care indefinitely (P<0.0005). Respondents were marginally more likely to pursue a court-appointed guardian for those patients whose families had nonreligious objections to withdrawal (P=0.05). Respondents who thought that a fear of being sued affected decisions were less likely to pursue unilateral withdrawal (odds ratio 0.8, 95% CI=0.6-0.9). Those who felt personal distress as a result of difficult EOL decision making, thought they often provided "futile" care, or those who felt EOL care was effectively addressed at the institution were less likely to want to defer to the parents' wishes (range of odds ratios 0.7-1).

CONCLUSION: In this randomized vignette study, we have shown that family factors, particularly how involved a family seems to be in a child's life, affect what clinicians think is ethically appropriate in challenging EOL cases. Knowledge of how a family's degree of involvement may affect clinicians should be helpful to the clinical ethics consultants and offer some degree of insight to the clinicians themselves.

DOI10.1016/j.jpainsymman.2012.05.005
Alternate JournalJ Pain Symptom Manage
PubMed ID23017620