Meert Kathleen L, Eggly Susan, Pollack Murray, Anand K J S, Zimmerman Jerry, Carcillo Joseph, Newth Christopher J L, Dean J Michael, Willson Douglas F, Nicholson Carol
Children's Hospital of Michigan, Detroit, MI 48201, USA.
Pediatr Crit Care Med. 2008 Jan;9(1):2-7. doi: 10.1097/01.PCC.0000298644.13882.88.
Communicating bad news about a child's illness is a difficult task commonly faced by intensive care physicians. Greater understanding of parents' scope of experiences with bad news during their child's hospitalization will help physicians communicate more effectively. Our objective is to describe parents' perceptions of their conversations with physicians regarding their child's terminal illness and death in the pediatric intensive care unit (PICU).
A secondary analysis of a qualitative interview study.
Six children's hospitals in the National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network.
Fifty-six parents of 48 children who died in the PICU 3-12 months before the study.
Parents participated in audio recorded semistructured telephone interviews. Interviews were analyzed using established qualitative methods.
Of the 56 parents interviewed, 40 (71%) wanted to provide feedback on the way information about their child's terminal illness and death was communicated by PICU physicians. The most common communication issue identified by parents was the physicians' availability and attentiveness to their informational needs. Other communication issues included honesty and comprehensiveness of information, affect with which information was provided, withholding of information, provision of false hope, complexity of vocabulary, pace of providing information, contradictory information, and physicians' body language.
The way bad news is discussed by physicians is extremely important to most parents. Parents want physicians to be accessible and to provide honest and complete information with a caring affect, using lay language, and at a pace in accordance with their ability to comprehend. Withholding prognostic information from parents often leads to false hopes and feelings of anger, betrayal, and distrust. Future research is needed to investigate whether the way bad news is discussed influences psychological adjustment and family functioning among bereaved parents.
传达关于儿童疾病的坏消息是重症监护医生常面临的一项艰巨任务。深入了解父母在孩子住院期间接收坏消息的经历范围，将有助于医生更有效地进行沟通。我们的目的是描述父母对在儿科重症监护病房（PICU）与医生就其孩子的绝症和死亡进行的谈话的看法。
对一项定性访谈研究的二次分析。
国家儿童健康与人类发展研究所儿科重症监护协作研究网络中的六家儿童医院。
48名在研究前3 - 12个月于PICU死亡的儿童的56名父母。
父母参与了录音的半结构化电话访谈。访谈采用既定的定性方法进行分析。
在接受访谈的56名父母中，40名（71%）希望就PICU医生传达其孩子绝症和死亡信息的方式提供反馈。父母指出的最常见沟通问题是医生是否有空以及对他们信息需求的关注程度。其他沟通问题包括信息的诚实性和全面性、提供信息时的态度、信息隐瞒、给予虚假希望、词汇复杂性、提供信息的速度、相互矛盾的信息以及医生的肢体语言。
医生讨论坏消息的方式对大多数父母极为重要。父母希望医生能够随时提供帮助，并以关怀的态度、使用通俗易懂的语言、按照他们的理解能力提供诚实且完整的信息。向父母隐瞒预后信息往往会导致虚假希望以及愤怒、被背叛和不信任的感觉。未来需要开展研究，以调查讨论坏消息的方式是否会影响丧亲父母的心理调适和家庭功能。
