Division Critical Care Medicine, Department of Pediatrics, George Washington University, Washington, DC, USA.
Pediatric Ethics Program, Children's National Hospital, Washington, DC, USA.
J Palliat Med. 2022 Mar;25(3):428-436. doi: 10.1089/jpm.2021.0063. Epub 2021 Sep 13.
To assess parental decision-making preferences when caring for a child with serious illness and to evaluate for an association between preferences and parental trust in physicians, and potential modification of this association by parental anxiety or depression. We analyzed cross-sectional data from 200 parents of 158 children in the United States who had life-threatening illnesses and whose attending physicians thought that the parents would have to make major medical decision in the next 12 to 24 months. Parents completed measures of decision-making preferences, trust in physicians, anxiety, and depression. Higher reported levels of trust were associated with lower preferences for autonomous decision making (Spearman correlation = -0.24; 95% confidence interval [CI] = -0.36 to -0.01; < 0.008). Among parents with higher levels of trust, increasing anxiety scores were associated with decreasing preference for autonomy, whereas among parents with lower levels of trust, increasing anxiety scores showed an increasing preference for autonomy (regression coefficient = -0.01; 95% CI = -0.02 to -0.001; ≤ 0.03). Decreasing trust in physicians is associated with a higher preference for autonomous decision making. Parents who have higher levels of anxiety exhibit this association more strongly. Decision support for parents of children with serious illness should use strategies to respect parental decision-making preferences, address potential distrust, and provide mental health support to parents who are anxious or depressed.
评估父母在照顾重病儿童时的决策偏好，并评估偏好与父母对医生的信任之间的关系，以及父母的焦虑或抑郁是否会对此关系产生影响。我们分析了来自美国 158 名患有危及生命疾病的 158 名儿童的 200 名父母的横断面数据，这些儿童的主治医生认为，在接下来的 12 至 24 个月内，父母将不得不做出重大医疗决策。父母完成了决策偏好、对医生的信任、焦虑和抑郁的评估。报告的信任水平越高，对自主决策的偏好越低（Spearman 相关系数=−0.24；95%置信区间[CI]为−0.36 至−0.01； < 0.008）。在信任水平较高的父母中，焦虑评分的增加与自主决策偏好的降低有关，而在信任水平较低的父母中，焦虑评分的增加与自主决策偏好的增加有关（回归系数=−0.01；95% CI=−0.02 至−0.001； ≤ 0.03）。对医生的信任度降低与自主决策偏好的增加有关。焦虑程度较高的父母表现出这种关联更强。为重病儿童的父母提供决策支持应该使用策略来尊重父母的决策偏好，解决潜在的不信任问题，并为焦虑或抑郁的父母提供心理健康支持。
