Campwala Rashida T, Schmidt Anita R, Chang Todd P, Nager Alan L
Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mail Stop 113, Los Angeles, CA, 90027, USA.
Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Int J Emerg Med. 2020 Mar 14;13(1):12. doi: 10.1186/s12245-020-0263-6.
Pediatric Advanced Life Support provides guidelines for resuscitating children in cardiopulmonary arrest. However, the role physicians' attitudes and beliefs play in decision-making when terminating resuscitation has not been fully investigated. This study aims to identify and explore the vital "non-medical" considerations surrounding the decision to terminate efforts by U.S.-based Pediatric Emergency Medicine (PEM) physicians.
A phenomenological qualitative study was conducted using PEM physician experiences in terminating resuscitation within a large freestanding children's hospital. Semi-structured interviews were conducted with 17 physicians, sampled purposively for their relevant content experience, and continued until the point of content saturation. Resulting data were coded using conventional content analysis by 2 coders; intercoder reliability was calculated as κ of 0.91. Coding disagreements were resolved through consultation with other authors.
Coding yielded 5 broad categories of "non-medical" factors that influenced physicians' decision to terminate resuscitation: legal and financial, parent-related, patient-related, physician-related, and resuscitation. When relevant, each factor was assigned a directionality tag indicating whether the factor influenced physicians to terminate a resuscitation, prolong a resuscitation, or not consider resuscitation. Seventy-eight unique factors were identified, 49 of which were defined by the research team as notable due to the frequency of their mention or novelty of concept.
Physicians consider numerous "non-medical" factors when terminating pediatric resuscitative efforts. Factors are tied largely to individual beliefs, attitudes, and values, and likely contribute to variability in practice. An increased understanding of the uncertainty that exists around termination of resuscitation may help physicians in objective clinical decision-making in similar situations.
儿科高级生命支持为心肺骤停儿童的复苏提供指导方针。然而，医生的态度和信念在终止复苏决策中所起的作用尚未得到充分研究。本研究旨在识别和探讨美国儿科急诊医学（PEM）医生在决定终止复苏努力时周围至关重要的“非医学”因素。
采用现象学定性研究方法，利用PEM医生在一家大型独立儿童医院终止复苏的经验。对17名医生进行了半结构化访谈，根据他们相关的内容经验进行有目的抽样，并持续到内容饱和点。由2名编码员使用常规内容分析法对所得数据进行编码；计算编码员间信度为κ值0.91。编码分歧通过与其他作者协商解决。
编码产生了5大类影响医生终止复苏决策的“非医学”因素：法律和财务、与家长相关、与患者相关、与医生相关以及复苏相关。在相关情况下，每个因素都被赋予一个方向性标签，表明该因素是影响医生终止复苏、延长复苏还是不考虑进行复苏。共识别出78个独特因素，其中49个因素由于被提及的频率或概念的新颖性被研究团队定义为值得注意的因素。
医生在终止儿科复苏努力时会考虑众多“非医学”因素。这些因素在很大程度上与个人信念、态度和价值观相关，并且可能导致实践中的差异。对复苏终止周围存在的不确定性有更多了解可能有助于医生在类似情况下进行客观的临床决策。
