Factors influencing termination of resuscitation in children: a qualitative analysis
Abstract Background Pediatric Advanced Life Support provides guidelines for resuscitating children in cardiopulmonary arrest. However, the role physicians’ attitudes and beliefs play in decision-making when terminating resuscitation has not been fully investigated. This study aims to identify and ex...
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doaj-55c30366870e49ff96aa5292040a54be2020-11-25T02:51:12ZengBMCInternational Journal of Emergency Medicine1865-13721865-13802020-03-0113111410.1186/s12245-020-0263-6Factors influencing termination of resuscitation in children: a qualitative analysisRashida T. Campwala0Anita R. Schmidt1Todd P. Chang2Alan L. Nager3Division of Emergency and Transport Medicine, Children’s Hospital Los AngelesDivision of Emergency and Transport Medicine, Children’s Hospital Los AngelesDivision of Emergency and Transport Medicine, Children’s Hospital Los AngelesDivision of Emergency and Transport Medicine, Children’s Hospital Los AngelesAbstract Background Pediatric Advanced Life Support provides guidelines for resuscitating children in cardiopulmonary arrest. However, the role physicians’ attitudes and beliefs play in decision-making when terminating resuscitation has not been fully investigated. This study aims to identify and explore the vital “non-medical” considerations surrounding the decision to terminate efforts by U.S.-based Pediatric Emergency Medicine (PEM) physicians. Methods A phenomenological qualitative study was conducted using PEM physician experiences in terminating resuscitation within a large freestanding children’s hospital. Semi-structured interviews were conducted with 17 physicians, sampled purposively for their relevant content experience, and continued until the point of content saturation. Resulting data were coded using conventional content analysis by 2 coders; intercoder reliability was calculated as κ of 0.91. Coding disagreements were resolved through consultation with other authors. Results Coding yielded 5 broad categories of “non-medical” factors that influenced physicians’ decision to terminate resuscitation: legal and financial, parent-related, patient-related, physician-related, and resuscitation. When relevant, each factor was assigned a directionality tag indicating whether the factor influenced physicians to terminate a resuscitation, prolong a resuscitation, or not consider resuscitation. Seventy-eight unique factors were identified, 49 of which were defined by the research team as notable due to the frequency of their mention or novelty of concept. Conclusion Physicians consider numerous “non-medical” factors when terminating pediatric resuscitative efforts. Factors are tied largely to individual beliefs, attitudes, and values, and likely contribute to variability in practice. An increased understanding of the uncertainty that exists around termination of resuscitation may help physicians in objective clinical decision-making in similar situations.http://link.springer.com/article/10.1186/s12245-020-0263-6Pediatric resuscitationTermination of resuscitationTermination of pediatric resuscitation |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Rashida T. Campwala Anita R. Schmidt Todd P. Chang Alan L. Nager |
spellingShingle |
Rashida T. Campwala Anita R. Schmidt Todd P. Chang Alan L. Nager Factors influencing termination of resuscitation in children: a qualitative analysis International Journal of Emergency Medicine Pediatric resuscitation Termination of resuscitation Termination of pediatric resuscitation |
author_facet |
Rashida T. Campwala Anita R. Schmidt Todd P. Chang Alan L. Nager |
author_sort |
Rashida T. Campwala |
title |
Factors influencing termination of resuscitation in children: a qualitative analysis |
title_short |
Factors influencing termination of resuscitation in children: a qualitative analysis |
title_full |
Factors influencing termination of resuscitation in children: a qualitative analysis |
title_fullStr |
Factors influencing termination of resuscitation in children: a qualitative analysis |
title_full_unstemmed |
Factors influencing termination of resuscitation in children: a qualitative analysis |
title_sort |
factors influencing termination of resuscitation in children: a qualitative analysis |
publisher |
BMC |
series |
International Journal of Emergency Medicine |
issn |
1865-1372 1865-1380 |
publishDate |
2020-03-01 |
description |
Abstract Background Pediatric Advanced Life Support provides guidelines for resuscitating children in cardiopulmonary arrest. However, the role physicians’ attitudes and beliefs play in decision-making when terminating resuscitation has not been fully investigated. This study aims to identify and explore the vital “non-medical” considerations surrounding the decision to terminate efforts by U.S.-based Pediatric Emergency Medicine (PEM) physicians. Methods A phenomenological qualitative study was conducted using PEM physician experiences in terminating resuscitation within a large freestanding children’s hospital. Semi-structured interviews were conducted with 17 physicians, sampled purposively for their relevant content experience, and continued until the point of content saturation. Resulting data were coded using conventional content analysis by 2 coders; intercoder reliability was calculated as κ of 0.91. Coding disagreements were resolved through consultation with other authors. Results Coding yielded 5 broad categories of “non-medical” factors that influenced physicians’ decision to terminate resuscitation: legal and financial, parent-related, patient-related, physician-related, and resuscitation. When relevant, each factor was assigned a directionality tag indicating whether the factor influenced physicians to terminate a resuscitation, prolong a resuscitation, or not consider resuscitation. Seventy-eight unique factors were identified, 49 of which were defined by the research team as notable due to the frequency of their mention or novelty of concept. Conclusion Physicians consider numerous “non-medical” factors when terminating pediatric resuscitative efforts. Factors are tied largely to individual beliefs, attitudes, and values, and likely contribute to variability in practice. An increased understanding of the uncertainty that exists around termination of resuscitation may help physicians in objective clinical decision-making in similar situations. |
topic |
Pediatric resuscitation Termination of resuscitation Termination of pediatric resuscitation |
url |
http://link.springer.com/article/10.1186/s12245-020-0263-6 |
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