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Open Access 30-06-2022 | Original

How doctors manage conflicts with families of critically ill patients during conversations about end-of-life decisions in neonatal, pediatric, and adult intensive care

Authors: Amber S. Spijkers, Aranka Akkermans, Ellen M. A. Smets, Marcus J. Schultz, Thomas G. V. Cherpanath, Job B. M. van Woensel, Marc van Heerde, Anton H. van Kaam, Moniek van de Loo, Dick L. Willems, Mirjam A. de Vos

Published in: Intensive Care Medicine | Issue 7/2022

Abstract

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.

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Title: How doctors manage conflicts with families of critically ill patients during conversations about end-of-life decisions in neonatal, pediatric, and adult intensive care
Authors: Amber S. Spijkers
Aranka Akkermans
Ellen M. A. Smets
Marcus J. Schultz
Thomas G. V. Cherpanath
Job B. M. van Woensel
Marc van Heerde
Anton H. van Kaam
Moniek van de Loo
Dick L. Willems
Mirjam A. de Vos
Publication date: 30-06-2022
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 7/2022
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-022-06771-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

How doctors manage conflicts with families of critically ill patients during conversations about end-of-life decisions in neonatal, pediatric, and adult intensive care

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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