Research output: Contribution to journal › Article › Academic › peer-review
How doctors manage conflicts with families of critically ill patients during conversations about end-of-life decisions in neonatal, pediatric, and adult intensive care. / Spijkers, Amber S.; Akkermans, Aranka; Smets, Ellen M. A. et al.
In: Intensive care medicine, Vol. 48, No. 7, 07.2022, p. 910-922.Research output: Contribution to journal › Article › Academic › peer-review
}
TY - JOUR
T1 - How doctors manage conflicts with families of critically ill patients during conversations about end-of-life decisions in neonatal, pediatric, and adult intensive care
AU - Spijkers, Amber S.
AU - Akkermans, Aranka
AU - Smets, Ellen M. A.
AU - Schultz, Marcus J.
AU - Cherpanath, Thomas G. V.
AU - van Woensel, Job B. M.
AU - van Heerde, Marc
AU - van Kaam, Anton H.
AU - van de Loo, Moniek
AU - Willems, Dick L.
AU - de Vos, Mirjam A.
N1 - Funding Information: This study is part of the research project ‘FamICom’, which was supported by ZonMw [Project Number 844001316]. ZonMw is the Dutch organization for healthcare research and innovation. ZonMW had no role in the design and conduct of the study. Publisher Copyright: © 2022, The Author(s).
PY - 2022/7
Y1 - 2022/7
N2 - Purpose: Intensive care is a stressful environment in which team-family conflicts commonly occur. If managed poorly, conflicts can have negative effects on all parties involved. Previous studies mainly investigated these conflicts and their management in a retrospective way. This study aimed to prospectively explore team-family conflicts, including its main topics, complicating factors, doctors’ conflict management strategies and the effect of these strategies. Methods: Conversations between doctors in the neonatal, pediatric, and adult intensive care unit of a large university-based hospital and families of critically ill patients were audio-recorded from the moment doubts arose whether treatment was still in patients’ best interest. Transcripts were coded and analyzed using a qualitative deductive approach. Results: Team-family conflicts occurred in 29 out of 101 conversations (29%) concerning 20 out of 36 patients (56%). Conflicts mostly concerned more than one topic. We identified four complicating context- and/or family-related factors: diagnostic and prognostic uncertainty, families’ strong negative emotions, limited health literacy, and burden of responsibility. Doctors used four overarching strategies to manage conflicts, namely content-oriented, process-oriented, moral and empathic strategies. Doctors mostly used content-oriented strategies, independent of the intensive care setting. They were able to effectively address conflicts in most conversations. Yet, if they did not acknowledge families’ cues indicating the existence of one or more complicating factors, conflicts were likely to linger on during the conversation. Conclusion: This study underlines the importance of doctors tailoring their communication strategies to the concrete conflict topic(s) and to the context- and family-related factors which complicate a specific conflict.
AB - Purpose: Intensive care is a stressful environment in which team-family conflicts commonly occur. If managed poorly, conflicts can have negative effects on all parties involved. Previous studies mainly investigated these conflicts and their management in a retrospective way. This study aimed to prospectively explore team-family conflicts, including its main topics, complicating factors, doctors’ conflict management strategies and the effect of these strategies. Methods: Conversations between doctors in the neonatal, pediatric, and adult intensive care unit of a large university-based hospital and families of critically ill patients were audio-recorded from the moment doubts arose whether treatment was still in patients’ best interest. Transcripts were coded and analyzed using a qualitative deductive approach. Results: Team-family conflicts occurred in 29 out of 101 conversations (29%) concerning 20 out of 36 patients (56%). Conflicts mostly concerned more than one topic. We identified four complicating context- and/or family-related factors: diagnostic and prognostic uncertainty, families’ strong negative emotions, limited health literacy, and burden of responsibility. Doctors used four overarching strategies to manage conflicts, namely content-oriented, process-oriented, moral and empathic strategies. Doctors mostly used content-oriented strategies, independent of the intensive care setting. They were able to effectively address conflicts in most conversations. Yet, if they did not acknowledge families’ cues indicating the existence of one or more complicating factors, conflicts were likely to linger on during the conversation. Conclusion: This study underlines the importance of doctors tailoring their communication strategies to the concrete conflict topic(s) and to the context- and family-related factors which complicate a specific conflict.
KW - Clinical decision making
KW - Communication
KW - Conflict resolution
KW - Intensive care
KW - Patient representatives
KW - Qualitative research
UR - http://www.scopus.com/inward/record.url?scp=85133188319&partnerID=8YFLogxK
U2 - 10.1007/s00134-022-06771-5
DO - 10.1007/s00134-022-06771-5
M3 - Article
C2 - 35773499
VL - 48
SP - 910
EP - 922
JO - Intensive care medicine
JF - Intensive care medicine
SN - 0342-4642
IS - 7
ER -
ID: 24873433