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The Parent Perspective: “Being a Good Parent” When Making Critical Decisions in the PICU

October, Tessie W. MD, MPH1,2; Fisher, Kiondra R. BS1; Feudtner, Chris MD, MPH, PhD3,4; Hinds, Pamela S. PhD, RN, FAAN2,5

Pediatric Critical Care Medicine: May 2014 - Volume 15 - Issue 4 - p 291–298
doi: 10.1097/PCC.0000000000000076
Feature Articles

Objective: To identify factors important to parents making decisions for their critically ill child.

Design: Prospective cross-sectional study.

Setting: Single center, tertiary care PICU.

Subjects: Parents making critical treatment decisions for their child.

Intervention: One-on-one interviews that used the Good Parent Tool-2 open-ended question that asks parents to describe factors important for parenting their ill child and how clinicians could help them achieve their definition of “being a good parent” to their child. Parent responses were analyzed thematically. Parents also ranked themes in order of importance to them using the Good Parent Ranking Exercise.

Measurement and Main Results: Of 53 eligible parents, 43 (81%) participated. We identified nine themes through content analysis of the parent’s narrative statements from the Good Parent Tool. Most commonly (60% of quotes) components of being a good parent described by parents included focusing on their child’s quality of life, advocating for their child with the medical team, and putting their child’s needs above their own. Themes key to parental decision making were similar regardless of parent race and socioeconomic status or child’s clinical status. We identified nine clinician strategies identified by parents as helping them fulfill their parenting role, most commonly, parents wanted to be kept informed (32% of quotes). Using the Good Parent Ranking Exercise, fathers ranked making informed medical decisions as most important, whereas mothers ranked focusing on the child’s health and putting their child’s needs above their own as most important. However, mothers who were not part of a couple ranked making informed medical decisions as most important.

Conclusion: These findings suggest a range of themes important for parents to “be a good parent” to their child while making critical decisions. Further studies need to explore whether clinician’s knowledge of the parent’s most valued factor can improve family-centered care.

1Department of Critical Care Medicine, Children’s National Medical Center, Washington, DC.

2Department of Pediatrics, George Washington University School of Medicine, Washington, DC.

3Department of Medical Ethics and Pediatric Advanced Care Team, Children’s Hospital of Philadelphia, Philadelphia, PA.

4Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

5Department of Nursing Research and Quality Outcomes, Children’s National Medical Center, Washington, DC.

This work was performed at Children’s National Medical Center, Washington, DC.

Supported, in part, by NICHD (grant number 5K12HD047349-08) and NINR (grant number 1RO1H5018425).

Dr. October received support for article research from the National Institutes of Health (NIH). Her institution received grant support from the NIH and NICHD. Dr. Feudtner received grant support from NIH R01 (developed the GP quantitative methodology with NIH support) and received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies