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End-of-life decisions in neonatal care: a conversation analytical study
- Source :
- Archives of Disease in Childhood - Fetal and Neonatal Edition. 106:184-188
- Publication Year :
- 2020
- Publisher :
- BMJ, 2020.
-
Abstract
- ObjectiveTo understand the dynamics of conversations between neonatologists and parents concerning limitation of life-sustaining treatments.DesignFormal conversations were recorded, transcribed and analysed according to the conventions and methods of conversation analysis.SettingTwo tertiary neonatal intensive care units.ParticipantsConsultant neonatal specialists and families.Main outcome measuresWe used conversation analysis and developed an inductive coding scheme for conversations based on the introduction of limiting life-sustaining treatments and on the parental responses.ResultsFrom recordings with 51 families, we identified 27 conversations about limiting life support with 20 families and 14 doctors. Neonatologists adopted three broad strategies: (1) ‘recommendations’, in which one course of action is presented and explicitly endorsed as the best course of action, (2) a ‘single-option choice’ format (conditional: referring to a choice that should be made, but without specifying or listing options), and (3) options (where the doctor explicitly refers to or lists options). Our conversation analysis-informed coding scheme was based on the opportunities available for parents to ask questions and assert their preference with minimal interactional constraint or pressure for a certain type of response. Response scores for parents presented with conditional formats (n=15, median 5.0) and options (n=10, median 5.0) were significantly higher than for those parents presented with ‘recommendations’ (n=16, median 3.75; p=0.002) and parents were more likely to express preferences (p=0.005).ConclusionEncouraging different approaches to conversations about limitation of life-supporting treatment may lead to better parent engagement and less misalignment between the conversational partners.
- Subjects :
- Parents
Palliative care
media_common.quotation_subject
Decision Making
Developmental psychology
Tertiary Care Centers
03 medical and health sciences
0302 clinical medicine
Neonatologists
Professional-Family Relations
Intensive Care Units, Neonatal
030225 pediatrics
Intensive care
Humans
Medicine
Conversation
030212 general & internal medicine
Qualitative Research
media_common
Terminal Care
business.industry
Communication
Infant, Newborn
Outcome measures
Obstetrics and Gynecology
General Medicine
Conversation analysis
Ask price
Life support
Pediatrics, Perinatology and Child Health
business
Life Support Systems
Coding (social sciences)
Subjects
Details
- ISSN :
- 14682052 and 13592998
- Volume :
- 106
- Database :
- OpenAIRE
- Journal :
- Archives of Disease in Childhood - Fetal and Neonatal Edition
- Accession number :
- edsair.doi.dedup.....40bfed75b4511f5e359d29e4248585d1