UNLABELLED: The fact that some children may survive despite a limitation of treatment decision (LTD) made in the pediatric intensive care unit (PICU) is a recent concern. A previous study pointed out that the teams in charge of children after the PICU stay did not take previous PICU LTDs into account. PURPOSE: To identify the problems different units experience in cooperating with the PICU team, in order to increase the continuity of care for these children. STUDY DESIGN: Qualitative single-center study, using semi-structured interviews with physicians in charge of children who were discharged from the PICU even though a LTD was made. RESULTS: Nine pediatric subspecialists (hemato-oncologists, neurologists, and neurosurgeons) were interviewed, producing a corpus of approximately 80 pages of typed text. Three conflictual situations were identified by these physicians. The most frequently reported situation was being asked by the PICU team to give expert advice on a patient's prognosis, before a LTD was made. The 2 others had to defend a true care plan for children who were transferred to the PICU and designing a new care plan for children who were discharged from the PICU after a LTD was made. CONCLUSION: The medical reasoning model that is used for LTDs in the PICU generates conflictual situations when compared to the models that are used in other specialties. These models represent various expressions of subjectivity, as in any medical decision. Acknowledging this fact could facilitate its integration into clinical practice and should improve authentic debates that are necessary to ensure continuity of care for these children.
UNLABELLED: The fact that some children may survive despite a limitation of treatment decision (LTD) made in the pediatric intensive care unit (PICU) is a recent concern. A previous study pointed out that the teams in charge of children after the PICU stay did not take previous PICU LTDs into account. PURPOSE: To identify the problems different units experience in cooperating with the PICU team, in order to increase the continuity of care for these children. STUDY DESIGN: Qualitative single-center study, using semi-structured interviews with physicians in charge of children who were discharged from the PICU even though a LTD was made. RESULTS: Nine pediatric subspecialists (hemato-oncologists, neurologists, and neurosurgeons) were interviewed, producing a corpus of approximately 80 pages of typed text. Three conflictual situations were identified by these physicians. The most frequently reported situation was being asked by the PICU team to give expert advice on a patient's prognosis, before a LTD was made. The 2 others had to defend a true care plan for children who were transferred to the PICU and designing a new care plan for children who were discharged from the PICU after a LTD was made. CONCLUSION: The medical reasoning model that is used for LTDs in the PICU generates conflictual situations when compared to the models that are used in other specialties. These models represent various expressions of subjectivity, as in any medical decision. Acknowledging this fact could facilitate its integration into clinical practice and should improve authentic debates that are necessary to ensure continuity of care for these children.
Authors: Robin Cremer; Philippe Hubert; Bruno Grandbastien; Grégoire Moutel; Francis Leclerc Journal: Intensive Care Med Date: 2011-08-16 Impact factor: 17.440