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Parental involvement in neonatal critical care decision-making

Shaw, C; Stokoe, E; Gallagher, K; Aladangady, N; Marlow, N; (2016) Parental involvement in neonatal critical care decision-making. Sociology of Health & Illness , 38 (8) pp. 1217-1242. 10.1111/1467-9566.12455. Green open access

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Abstract

The article analyses the decision-making process between doctors and parents of babies in neonatal intensive care. In particular, it focuses on cases in which the decision concerns the redirection of care from full intensive care to palliative care at the end of life. Thirty one families were recruited from a neonatal intensive care unit in England and their formal interactions with the doctor recorded. The conversations were transcribed and analysed using conversation analysis. Analysis focused on sequences in which decisions about the redirection of care were initiated and progressed. Two distinct communicative approaches to decision-making were used by doctors: ‘making recommendations’ and ‘providing options’. Different trajectories for parental involvement in decision-making were afforded by each design, as well as differences in terms of the alignments, or conflicts, between doctors and parents. ‘Making recommendations’ led to misalignment and reduced opportunities for questions and collaboration; ‘providing options’ led to an aligned approach with opportunities for questions and fuller participation in the decision-making process. The findings are discussed in the context of clinical uncertainty, moral responsibility and the implications for medical communication training and guidance.

Type: Article
Title: Parental involvement in neonatal critical care decision-making
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/1467-9566.12455
Publisher version: http://doi.org/10.1111/1467-9566.12455
Language: English
Additional information: © 2016 Foundation for the Sociology of Health & Illness. All rights reserved.
Keywords: Biomedical, Sociology, Biomedical Social Sciences, neonatal, end-of-life, decision-making, ethics, parental involvement, conversation analysis, Shared Decision, Medical Authority, Communication, Conversation, Life, End, Recommendations, Interrogatives, Consultations, Resistance
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Maternal and Fetal Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Neonatology
URI: https://discovery.ucl.ac.uk/id/eprint/1520003
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