Trust me I'm a doctor: Making decisions about children's direction of care

Isaacs, David

doi:10.1111/jpc.14588

Cited by 7 publications

(15 citation statements)

References 12 publications

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“…We presented the viewpoints of a youth, parent and paediatrician who are experienced health‐care consumers and providers on using SDM in paediatric clinical practice. Paediatric health care has shifted towards patient and family centred care . Consistent with the literature, we are advocating that SDM is essential for achieving evidence‐based health decision‐making and family centred care, and should be a routine part of paediatric health‐care decision‐making …”

Section: Discussionmentioning

confidence: 54%

“…The importance of incorporating the patient and family voice in decisions is increasingly being recognised among policy makers for promoting best outcomes . SDM is a low risk, low cost and high yield evidence‐based health intervention that improves health and decision outcomes . We presented the viewpoints of a youth, parent and paediatrician who are experienced health‐care consumers and providers on using SDM in paediatric clinical practice.…”

Section: Discussionmentioning

confidence: 99%

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Is sharing really caring? Viewpoints on shared decision‐making in paediatrics

Jordan¹,

Tremblay²,

Lipstein

et al. 2020

J Paediatrics Child Health

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Shared decision-making (SDM), the cornerstone of family-centred care and the gold standard in health decision-making, occurs when the patient, family members and the health-care team members partner to make health decisions about the child. This partnership involves an exchange of medical information and information about patient/family preferences and values. Together, the health-care team, parent and patient deliberate to determine the best course of action for the child. Despite high-quality evidence supporting its positive impact on outcomes, SDM has not been widely adopted in paediatric clinical practice. Greater understanding of the impact of SDM on all members of the decision triad (parent, patient and health-care provider) may increase the likelihood of SDM adoption. Therefore, we present the viewpoints of a paediatric patient, parent and paediatrician about the use of SDM. A youth living with a rare chronic disease discusses the impacts of being involved and excluded from health decisions. A mother of a son living with a rare nephrotic condition discusses working with a health-care team who are committed and skilled in SDM and the positive impacts SDM has had for her son's care. A general paediatrician with research expertise in SDM discusses the individual and system level challenges and rewards of using SDM in her clinical practice. Based on the viewpoints presented, we offer pragmatic recommendations for using SDM in paediatric clinical practice.Early in their development, we teach children to share. As social beings, sharing is a vital life skill that encourages us to recognise and respond to the needs of others and collaborate to achieve a common goal. Sharing shows compassion, respect, and care for our fellow humans. In paediatric health care, it is reasonable to expect that sharing be a basic, natural and humanistic approach for clinicians, children and families to achieve a common goal: the best health outcomes for the child. In fact, sharing health decisions can improve patient outcomes. 1 In paediatrics, shared decision-making (SDM) happens when the health-care team, parents and child collaborate as partners to make health decisions. 2 Simply put, the health-care team shares their expert knowledge (i.e. evidence) and clinical experience, the parent and child share their expertise about their values, preferences and circumstances, and together they discuss and decide on the best treatment plan for the child. 3 Unlike paternalistic or autonomous decision-making, the onus is not on one person (i.e. the child) to make the final decision, but rather the decision is equitably (not necessarily equally) shared in a manner consistent with the child's developmental abilities and the child and parent's preferences for involvement.Despite being at the core of patient and family-centred care and necessary to achieve evidence-based health decisionmaking, 4,5 SDM is not common practice in paediatrics. 6,7 Here, we present the independent viewpoints of a youth, parent and paediatrician on the importance and ch...

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Is sharing really caring? Viewpoints on shared decision‐making in paediatrics

Jordan¹,

Tremblay²,

Lipstein

et al. 2020

J Paediatrics Child Health

View full text Add to dashboard Cite

show abstract

“…But hospital executive need to support staff by endorsing them setting limits on aggressive behaviour and enforcing those limits. This might involve developing a plan of graded warnings, with exclusion first from the bedside and then from the hospital for increasing periods of time for repeated infractions 5 …”

Section: Figurementioning

confidence: 99%

Compromise

Isaacs

2021

J Paediatrics Child Health

Self Cite

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The word compromise is a strange beast. It can be used both as a verb and as a noun. It derives from the Latin comprissum meaning a mutual promise, through Old French compromis and late Middle English when compromise meant mutual consent to arbitration.Like so many English words in current use, it was introduced into the vernacular by William Shakespeare. In The Merchant of Venice, Shylock tells Antonio a story about how Jacob and his uncle Laban compromised over a flock of sheep (Fig. 1). Here, Shakespeare uses the word as meaning to reach an agreement, a negotiation.In Greek mythology, Persephone, the daughter of Zeus and Demeter, goddess of fertility and crops, was abducted by Hades and taken into the Underworld. Her mother's pining resulted in eternal winter. Zeus pleaded with his brother Hades to free Persephone, but Hades tricked her into eating six pomegranate seeds. Anyone who has eaten in the Underworld cannot leave. However, Zeus persuaded Hades to compromise. Persephone could remain in the Underworld for 6 months each year (one for each pomegranate seed), the winter, and could roam the Earth for the other 6 months, bringing spring, summer and the flourishing of crops.

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“…21 Yet less resource-restricted treatments and interventions, like active cardiopulmonary resuscitation, prolonged parenteral nutrition and prolonged artificial ventilation, have been the focus of futility discussions in these recent cases because they are for many patients, interventions that maintain life in the PICU. 22 Decisions not to provide these interventions on the basis of futility are therefore extremely emotive, complex and therefore require a reasoned and transparent decision-making process. 23…”

Section: Introductionmentioning

confidence: 99%

Children, futility and parental disagreement: The importance of ethical reasoning for clinicians in the paediatric intensive care setting

Baiocchi

Horowicz

2022

Clinical Ethics

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The provision of intensive care enables the lives of neonates, infants and children to be sustained or extended in circumstances previously regarded as impossible. However, as well as benefits, such care may confer burdens that resultingly frame continuation of certain interventions as futile, conferring more harm than or any, benefit. Subsequently, clinicians and families in the paediatric intensive care unit are often faced with decisions to withdraw, withhold or limit intensive care in order to act in the best interests of the child. An integral consideration in respect of these decisions is that futility is a concept that has to be contextualised for all those involved. Recent high-profile legal cases highlight the professional, clinical, legal and social conflicts that can arise when parents and clinicians have different interpretations of futility. In acknowledging the complexity of these conflicts for clinicians, this paper aims to support a better understanding of futility as an integral concept in such difficult and emotive decisions within professional practice. We utilise the concept of futility to frame how these decisions to withdraw or withhold certain invasive life-prolonging interventions are ethically and legally justifiable, even when they disagree or conflict with parental views. To support clinicians in understanding these decisions, we in part use the familiar bioethical framework of Principlism developed by Beauchamp and Childress. We suggest that understanding legal and ethical analysis of futility ultimately will help clinicians in approaching and reflecting on such decision-making.

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Trust me I'm a doctor: Making decisions about children's direction of care

Cited by 7 publications

References 12 publications

Is sharing really caring? Viewpoints on shared decision‐making in paediatrics

Is sharing really caring? Viewpoints on shared decision‐making in paediatrics

Compromise

Children, futility and parental disagreement: The importance of ethical reasoning for clinicians in the paediatric intensive care setting

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