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Purpose In intensive care units (ICUs), decisions about the continuation or discontinuation of life-sustaining treatment (LST) are made on a daily basis. Professional guidelines recommend an open exchange of standpoints and underlying arguments between doctors and families to arrive at the most appropriate decision. Yet, it is still largely unknown how doctors and families argue in real-life conversations. This study aimed to (1) identify which arguments doctors and families use in support of standpoints to continue or discontinue LST, (2) investigate how doctors and families structure their arguments, and (3) explore how their argumentative practices unfold during conversations. Method A qualitative inductive thematic analysis of 101 audio-recorded conversations between doctors and families. Results Seventy-one doctors and the families of 36 patients from the neonatal, pediatric, and adult ICU (respectively, N-ICU, P-ICU, and A-ICU) of a large university-based hospital participated. In almost all conversations, doctors were the first to argue and families followed, thereby either countering the doctor's line of argumentation or substantiating it. Arguments put forward by doctors and families fell under one of ten main types. The types of arguments presented by families largely overlapped with those presented by doctors. A real exchange of arguments occurred in a minority of conversations and was generally quite brief in the sense that not all possible arguments were presented and then discussed together. Conclusion This study offers a detailed insight in the argumentation practices of doctors and families, which can help doctors to have a sharper eye for the arguments put forward by doctors and families and to offer room for true deliberation., Author(s): Aranka Akkermans [sup.1] [sup.2], Sanne Prins [sup.1] [sup.2], Amber S. Spijkers [sup.1] [sup.2], Jean Wagemans [sup.3], Nanon H. M. Labrie [sup.4], Dick L. Willems [sup.5], Marcus J. Schultz [sup.6] [...]

Purpose Intensive care is a stressful environment in which team-family conflicts commonly occur. If managed poorly, conflicts can have negative effects on all parties involved. Previous studies mainly investigated these conflicts and their management in a retrospective way. This study aimed to prospectively explore team-family conflicts, including its main topics, complicating factors, doctors' conflict management strategies and the effect of these strategies. Methods Conversations between doctors in the neonatal, pediatric, and adult intensive care unit of a large university-based hospital and families of critically ill patients were audio-recorded from the moment doubts arose whether treatment was still in patients' best interest. Transcripts were coded and analyzed using a qualitative deductive approach. Results Team-family conflicts occurred in 29 out of 101 conversations (29%) concerning 20 out of 36 patients (56%). Conflicts mostly concerned more than one topic. We identified four complicating context- and/or family-related factors: diagnostic and prognostic uncertainty, families' strong negative emotions, limited health literacy, and burden of responsibility. Doctors used four overarching strategies to manage conflicts, namely content-oriented, process-oriented, moral and empathic strategies. Doctors mostly used content-oriented strategies, independent of the intensive care setting. They were able to effectively address conflicts in most conversations. Yet, if they did not acknowledge families' cues indicating the existence of one or more complicating factors, conflicts were likely to linger on during the conversation. Conclusion This study underlines the importance of doctors tailoring their communication strategies to the concrete conflict topic(s) and to the context- and family-related factors which complicate a specific conflict., Author(s): Amber S. Spijkers [sup.1] [sup.2], Aranka Akkermans [sup.1] [sup.2], Ellen M. A. Smets [sup.1] [sup.2], Marcus J. Schultz [sup.3] [sup.4] [sup.5], Thomas G. V. Cherpanath [sup.3], Job B. M. [...]

Objectives: In palliative care, it is important for family caregivers to spend time with and care for the patient, and to receive (in)formal support. These elements were compromised during the Covid-19-pandemic. This study investigates what family caregivers of non-Covid-19-patients in the palliative phase shared online during the first wave of the pandemic, and what their communicative intentions were with posting online. Methods: To investigate what family caregivers shared online, a reflexive thematic analysis was performed on online newspaper articles and posts on Twitter, Facebook and online forums. To investigate family caregivers' communicative intentions with social media posts, content analysis was conducted guided by Speech Act Theory. Results: In total, 412 posts and articles were included, the majority being Tweets (86.7%). Four themes were constructed: 1) 'Being out of touch', 2) 'Fear, worries and uncertainties, 3) 'Disbelief, anger and resistance', and 4) 'Understanding, acceptance and gratitude'. Family caregivers felt overwhelmed with anger, sadness and anxiety, yet some expressing milder or positive attitudes towards the new circumstances. Family caregivers mostly posted online to share their personal experiences and emotions, and to express their opinions about the restrictions. Conclusions: The pandemic had distinct implications for family caregivers of non-Covid-19-patients in the palliative phase. In future similar circumstances, restrictions should be tailored to individual conditions and interventions should be in place to facilitate contact between patients, family caregivers and healthcare professionals and to support family caregivers. [ABSTRACT FROM AUTHOR]

In neonatal and pediatric intensive care, physicians make treatment decisions on the child's behalf in close cooperation with parents. Prevailing uncertainties make these decisions extra complex. Adequately communicating with parents may be pivotal, as this could improve the decision-making process and parents' coping in the short and longer term. In this observational study, we aimed to investigate how physicians discuss uncertainty with parents, and how this discussion develops over time during the child's illness- and treatment trajectory. Physicians working at neonatal and pediatric intensive care units of three university medical centers audio recorded their conversations with parents, starting from the moment doubts arose whether treatment was still in the child's best interests. The researchers inductively coded transcripts of these conversations (Nconversations= 29; Ncases= 8). The identification of the topic to which uncertainty pertained and which communicative strategy the physician used, guided the analysis. Analysis was done by means of MAXQDA. Physicians discussed many uncertainties with parents regarding a large variety of topics, including uncertainty about the efficacy, risks and necessity of treatment, and the process of dying. Physicians adapted the way they discussed uncertainty to the specific phase of the child's illness and treatment trajectory. When there were still treatment options available, physicians primarily provided explanations or presented short-term action plans. When the child's death was imminent, physicians rather eliminated most uncertainty. By means of this prospective study, we obtained a detailed overview of how physicians discuss uncertainty with parents. We identified a wide array of strategies available for physicians to discuss uncertainty throughout different phases of the child's illness- and treatment trajectory. Our insights will help physicians to be more aware of the communicative strategies they use and to better tailor these strategies to parents' specific needs in and over the phases of the trajectory. [ABSTRACT FROM AUTHOR]