Sources of and Approaches to Family-Clinician Conflict From a National Survey of Pediatric Critical Care Leaders.

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.