End-of-life decisions in neonatal care: a conversation analytical study

Marlow, Neil and Shaw, Chloe and Connabeer, Kathrina and Aladangady, Narendra and Gallagher, Katie and Drew, Paul (2020) End-of-life decisions in neonatal care: a conversation analytical study. BMJ Archives of Disease in Childhood-Fetal and Neonatal Edition. ISSN 1359-2998

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Abstract

Objective
To understand the dynamics of conversations between neonatologists and parents concerning limitation of life-sustaining treatments.

Design
Formal conversations were recorded, transcribed and analysed according to the conventions and methods of conversation analysis.

Setting
Two tertiary neonatal intensive care units.

Participants
Consultant neonatal specialists and families.

Main outcome measures
We used conversation analysis and developed an inductive coding scheme for conversations based on the introduction of limiting life-sustaining treatments and on parental responses.

Results
From recordings with 51 families, we identified 27 conversations about limiting life support with 20 families and 14 doctors. Neonatologists adopted three broad strategies: (1) ’recommendations’, in which one course of action is presented and explicitly endorsed as the best course of action, (2) a ’single-option choice’ format (conditional: referring to a choice that should be made, but without specifying or listing options), and (3) options (where the doctor explicitly refers to or lists options). Our conversation analysis informed coding scheme was based on the opportunities available for parents to ask questions and assert their preference with minimal interactional constraint or pressure for a certain type of response. Response scores for parents presented with conditional formats (n=15, median 5.0) and options (n=10, median 5.0) were significantly higher than for those parents presented with ’recommendations’ (n=16, median 3.75; p=0.002) and parents were more likely to express preferences (p=0.005).

Conclusion
Encouraging different approaches to conversations about limitation of life-supporting treatment may lead to better parent engagement and less misalignment between the conversational partners.

Item Type: Article
Identification Number: https://doi.org/10.1136/archdischild-2020-319544
Date: 17 September 2020
Subjects: A300 Clinical Medicine
B700 Nursing
C800 Psychology
L300 Sociology
Q100 Linguistics
Divisions: Faculty of Business, Law and Social Sciences > School of Social Sciences > Dept. Psychology
REF UoA Output Collections > REF2021 UoA 04: Psychology, Psychiatry and Neuroscience
Depositing User: Kathrina Connabeer
Date Deposited: 25 Sep 2020 10:30
Last Modified: 06 Oct 2020 14:20
URI: http://www.open-access.bcu.ac.uk/id/eprint/9943

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