Decision-making dilemmas of paediatricians: a qualitative study in Japan

Abstract

ObjectiveTo delineate the critical decision-making processes that paediatricians apply when treating children with life-threatening conditions and the psychosocial experience of paediatricians involved in such care.DesignWe conducted semistructured, individual face-to-face interviews for each participant from 2014 to 2015. The content of each interview was subjected to a comprehensive qualitative analysis. The categories of dilemma were extracted from a second-round content analysis.ParticipantsParticipants were board-certified paediatricians with sufficient experience in making decisions in relation to children with severe illnesses or disabilities. We repeated purposive sampling and analyses until we reached saturation of the category data.ResultsWe performed interviews with 15 paediatricians. They each reported both unique and overlapping categories of dilemmas that they encountered when making critical decisions. The dilemmas included five types of causal elements: (1) paediatricians’ convictions; (2) the quest for the best interests of patients; (3) the quest for medically appropriate plans; (4) confronting parents and families and (5) socioenvironmental issues. Dilemmas occurred and developed as conflicting interactions among these five elements. We further categorised these five elements into three principal domains: the decision-maker (decider); consensus making among families, colleagues and society (process) and the consequential output of the decision (consequence).ConclusionsThis is the first qualitative study to demonstrate the framework of paediatricians’ decision-making processes and the complex structures of dilemmas they face. Our data indicate the necessity of establishing and implementing an effective support system for paediatricians, such as structured professional education and arguments for creating social consensus that assist them to reach the best plan for the management of severely ill children.

The relationship between proxy agency and the medical decisions concerning pediatric patients in palliative care: a qualitative study

“…They are focused on decision-making informed more by internal than external values, and aim to act in the child's best interest to find the best therapeutic options and help the family to provide adequate care at home. These dilemmas were not observed in this study; rather, the difficulties faced by the members of the PC team revolve around communication barriers between them and the attending physicians, lack of space, and financial hardship of the families they serve, making clear the socio-cultural contrast between countries like Japan and Mexico with different health care systems [21].…”

“…The experience of health professionals is described in an environment of multifaceted emotional tension, of concern for the well-being of the child and their family in their socio-economic context [21]., in a study carried out in Japan, describe the dilemmas faced by pediatricians in children's palliative care. They are focused on decision-making informed more by internal than external values, and aim to act in the child's best interest to find the best therapeutic options and help the family to provide adequate care at home.…”

The Relationship Between Proxy Agency and the Medical Decisions Concerning Pediatric Patients in Palliative Care: A Qualitative Study.

“…They are focused on decision-making informed more by internal than external values, and aim to act in the child's best interest to nd the best therapeutic options and help the family to provide adequate care at home. These dilemmas were not observed in this study; rather, the di culties faced by the members of the PC team revolve around communication barriers between them and the attending physicians, lack of space, and nancial hardship of the families they serve, making clear the sociocultural contrast between countries like Japan and Mexico with different health care systems (Sasazuki et al, 2019).…”

“…The experience of health professionals is described in an environment of multifaceted emotional tension, of concern for the well-being of the child and their family in their socio-economic context. (Sasazuki et al 2019), in a study carried out in Japan, describe the dilemmas faced by pediatricians in children's palliative care. They are focused on decision-making informed more by internal than external values, and aim to act in the child's best interest to nd the best therapeutic options and help the family to provide adequate care at home.…”

Til barnets beste? Beslutningsprosessen om å avslutte livsforlengende behandling

“…Det mangler relevant og tilstrekkelig forskning om dette temaet (6). Tidlige diskusjoner om beslutninger rundt behandlingen er ønskelig, men det mangler gode retningslinjer som kan vaere til hjelp i beslutningsprosessen, og som kan bidra til konsensus mellom alle som er involvert i medisinsk behandling av og sykepleie til alvorlig syke barn (6,7).…”