Academic pediatrics · 2026
Sources of and Approaches to Family-Clinician Conflict From a National Survey of Pediatric Critical Care Leaders.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Olszewski Aleksandra E, Shah Seema K, Barrera Leonardo, Castillo Leopoldo, Kolaitis Irini, Goodman Denise M, Paquette Erin Talati
Аннотация
OBJECTIVE: We sought to characterize sources of pediatric intensive care unit (PICU) conflict, and whether clinicians agree about when and how to implement shared decision-making (SDM) in conflicts.
METHODS: This national, multi-center, prospective mixed methods study surveyed 120 physician and nurse PICU directors. Chi-square and Fisher's exact test tested differences by respondent characteristics. Dependent variables were mediation techniques, escalation reasons, interventions for imposing limits, and behavior contract use. Content analysis was used for qualitative data.
RESULTS: Of 120 invited leaders (98 physician directors, 22 nurse directors), 68 responded (59 physicians, 9 nurses). After excluding surveys <30% complete, 60 surveys were included in the analysis. Respondent and institutional characteristics varied. PICU sizes were evenly distributed. There was less agreement on how to address conflict in cases where existing pediatric decision-making frameworks would recommend overriding caregiver preferences to prevent serious harm. Those with more clinical experience were less likely to escalate conflicts. Those at larger institutions were more likely to report conflict policies.
CONCLUSIONS: Reported PICU conflict sources were variable, and leaders' approaches differed based on experience, decision type, and conflict type. We present a descriptive account of approaches to managing conflict for future testing and implementation. Resources tailored to conflicts that are predisposed to disagreements may decrease conflict incidence and improve management, thereby improving patient and caregiver outcomes, moral distress, and burnout for clinical teams.
METHODS: This national, multi-center, prospective mixed methods study surveyed 120 physician and nurse PICU directors. Chi-square and Fisher's exact test tested differences by respondent characteristics. Dependent variables were mediation techniques, escalation reasons, interventions for imposing limits, and behavior contract use. Content analysis was used for qualitative data.
RESULTS: Of 120 invited leaders (98 physician directors, 22 nurse directors), 68 responded (59 physicians, 9 nurses). After excluding surveys <30% complete, 60 surveys were included in the analysis. Respondent and institutional characteristics varied. PICU sizes were evenly distributed. There was less agreement on how to address conflict in cases where existing pediatric decision-making frameworks would recommend overriding caregiver preferences to prevent serious harm. Those with more clinical experience were less likely to escalate conflicts. Those at larger institutions were more likely to report conflict policies.
CONCLUSIONS: Reported PICU conflict sources were variable, and leaders' approaches differed based on experience, decision type, and conflict type. We present a descriptive account of approaches to managing conflict for future testing and implementation. Resources tailored to conflicts that are predisposed to disagreements may decrease conflict incidence and improve management, thereby improving patient and caregiver outcomes, moral distress, and burnout for clinical teams.