Physicians' decision-making when managing pediatric patients with prolonged disorders of consciousness
a qualitative study
Informazioni aggiuntive
Autori
Merlo F.,
Malacrida R.,
Hurst-Majno S.,
Bassetti C. L. A.,
Albanese E.,
Fadda M.
Tipo
Articolo pubblicato in rivista scientifica
Anno
2022
Lingua
Inglese
Sommario
Background and purpose: Advances in medicine have resulted in treatments that can
extend the survival of patients with prolonged disorders of consciousness (PDOC) for
several years. However, several diagnostic and prognostic uncertainties remain, particularly in the care of pediatric patients. In the absence of international guidelines, we aimed
to explore physicians' decision-making when managing pediatric patients with PDOC.
Methods: We conducted a qualitative study using semistructured, individual interviews
and employed an inductive thematic analytical approach to explore physicians' subjective experiences and decision-making when managing pediatric patients with PDOC. We
recruited a purposive sample of 19 Italian-speaking physicians currently or previously
employed in intensive care units or pediatric, internal medicine, or neurology departments in Switzerland.
Results: Participants stated that making clinical decisions involving pediatric patients with
PDOC is extremely challenging, because the decisional process requires finding a balance
between several contending factors. We found that physicians experienced ambivalence
in three domains of care (time, goals of care, and target of care), and that they were aware
of the risk of self-fulfilling prophecies for both prognosis and main clinical outcomes.
Conclusions: Our study confirmed that experienced clinicians acknowledge the complex
nature and challenge of clinical decision-making in the care of pediatric patients with
PDOC. More research is warranted to improve and expand existing guidelines aimed at
assisting and facilitating clinical and ethical decision-making, and improving physicians'
awareness of the factors affecting their decisions when dealing with patients with PDOC.
Parole chiave
Decision-making, Ethics, Pediatrics, Physicians, Prolonged disorders of consciousness
Periodico
European journal of neurology
Volume
29
Numero ( Mese )
8
Pagine (o numero dell’articolo)
2181-2191
Diffusione
Licenza
CC BY-NC-ND
Visibilità
Pubblico
Status open access
Gold
