Merlo, Federica; Malacrida, Roberto; Hurst, Samia; Bassetti, Claudio L A; Albanese, Emiliano; Fadda, Marta (2022). Physicians' decision-making when managing pediatric patients with prolonged disorders of consciousness: A qualitative study. European journal of neurology, 29(8), pp. 2181-2191. Wiley 10.1111/ene.15354
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Euro_J_of_Neurology_-_2022_-_Merlo_-_Physicians_decision_making_when_managing_pediatric_patients_with_prolonged_disorders.pdf - Accepted Version Available under License Publisher holds Copyright. Download (1MB) | Preview |
BACKGROUND
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 semi-structured, 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 unit, 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 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.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology |
UniBE Contributor: |
Bassetti, Claudio L.A. |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1468-1331 |
Publisher: |
Wiley |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
12 Apr 2022 12:20 |
Last Modified: |
12 Apr 2023 00:25 |
Publisher DOI: |
10.1111/ene.15354 |
PubMed ID: |
35398947 |
Uncontrolled Keywords: |
Ethics decision-making pediatrics physicians prolonged disorders of consciousness |
BORIS DOI: |
10.48350/169231 |
URI: |
https://boris.unibe.ch/id/eprint/169231 |
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