Parental hopeful patterns of thinking, emotions, and pediatric palliative care decision making: a prospective cohort study.

TitleParental hopeful patterns of thinking, emotions, and pediatric palliative care decision making: a prospective cohort study.
Publication TypeJournal Article
Year of Publication2010
AuthorsFeudtner C, Carroll KW, Hexem KR, Silberman J, Kang TI, Kazak AE
JournalArch Pediatr Adolesc Med
Volume164
Issue9
Pagination831-9
Date Published2010 Sep
ISSN1538-3628
KeywordsAdolescent, Adult, Child, Child, Preschool, Decision Making, Emotions, Female, Humans, Infant, Male, Palliative Care, Parents, Prospective Studies, Thinking
Abstract

OBJECTIVE: To test the hypothesis that hopeful patterns of thoughts and emotions of parents of pediatric patients receiving palliative care consultative services are related to subsequent decisions, specifically regarding limit of intervention (LOI) orders.

DESIGN: Prospective cohort study.

SETTING: Children's hospital and surrounding region.

PARTICIPANTS: Thirty-three pediatric patients receiving palliative care consultative services who did not have LOI orders at time of cohort entry and their 43 parental adults.

MAIN EXPOSURES: Parental levels at time of cohort entry of hopeful patterns of thinking and emotions, in conjunction with perceptions about patients' health trajectories.

MAIN OUTCOME MEASURE: Enactment of an LOI order after entry into the cohort.

RESULTS: During the 6 months of observation, 14 patients (42.4%) had an LOI order enacted. In adjusted analyses, higher levels of parental hopeful patterns of thinking were significantly associated with increased odds of enactment of an LOI order (adjusted odds ratio [AOR], 2.73; 95% confidence interval [CI], 1.04-7.22). Increased odds of LOI enactment were associated to nonsignificant degrees with lower levels of parental positive affect (AOR, 0.44; 95% CI, 0.17-1.12), higher levels of parental negative affect (AOR, 2.02; 95% CI, 0.98-4.16), and parental perceptions of worsening health over time (AOR, 1.72; 95% CI, 0.73-4.07).

CONCLUSION: For pediatric patients receiving palliative care consultative services, higher levels of parents' hopeful patterns of thinking are associated with subsequent enactment of LOI orders, suggesting that emotional and cognitive processes have a combined effect on medical decision making.

DOI10.1001/archpediatrics.2010.146
Alternate JournalArch Pediatr Adolesc Med
PubMed ID20819965
PubMed Central IDPMC3856654
Grant ListR21 NR010026 / NR / NINR NIH HHS / United States
R21NR010026 / NR / NINR NIH HHS / United States