Sasso Corbaro Foundation, Bellinzona, Switzerland.
Faculty of Biomedical Sciences, Institute of Public Health, Università della Svizzera italiana, Lugano, Switzerland.
Eur J Neurol. 2022 Aug;29(8):2181-2191. doi: 10.1111/ene.15354. Epub 2022 Apr 26.
Advances in medicine have resulted in treatments that can extend the survival of patients with prolonged disorders of consciousness (PDOC) for several years. However, several diagnostic and prognostic uncertainties remain, particularly in the care of pediatric patients. In the absence of international guidelines, we aimed to explore physicians' decision-making when managing pediatric patients with PDOC.
We conducted a qualitative study using semistructured, individual interviews and employed an inductive thematic analytical approach to explore physicians' subjective experiences and decision-making when managing pediatric patients with PDOC. We recruited a purposive sample of 19 Italian-speaking physicians currently or previously employed in intensive care units or pediatric, internal medicine, or neurology departments in Switzerland.
Participants stated that making clinical decisions involving pediatric patients with PDOC is extremely challenging, because the decisional process requires finding a balance between several contending factors. We found that physicians experienced ambivalence in three domains of care (time, goals of care, and target of care), and that they were aware of the risk of self-fulfilling prophecies for both prognosis and main clinical outcomes.
Our study confirmed that experienced clinicians acknowledge the complex nature and challenge of clinical decision-making in the care of pediatric patients with PDOC. More research is warranted to improve and expand existing guidelines aimed at assisting and facilitating clinical and ethical decision-making, and improving physicians' awareness of the factors affecting their decisions when dealing with patients with PDOC.
医学的进步带来了一些治疗方法，可以使患有长时间意识障碍（PDOC）的患者的生存时间延长数年。然而，仍存在一些诊断和预后方面的不确定性，尤其是在儿科患者的护理方面。在缺乏国际指南的情况下，我们旨在探讨医生在管理患有 PDOC 的儿科患者时的决策过程。
我们进行了一项定性研究，使用半结构式个体访谈，并采用归纳主题分析方法来探讨医生在管理患有 PDOC 的儿科患者时的主观经验和决策过程。我们招募了来自瑞士的 19 名讲意大利语的医生，他们目前或曾经在重症监护病房或儿科、内科或神经内科工作。
参与者表示，涉及患有 PDOC 的儿科患者的临床决策极具挑战性，因为决策过程需要在几个相互竞争的因素之间找到平衡。我们发现，医生在三个护理领域（时间、护理目标和护理目标）中存在矛盾心理，并且他们意识到对预后和主要临床结局的自我实现预言的风险。
我们的研究证实，经验丰富的临床医生认识到在照顾患有 PDOC 的儿科患者时，临床决策的复杂性和挑战性。需要进一步研究以改进和扩展现有的指南，旨在协助和促进临床和伦理决策，并提高医生在处理 PDOC 患者时对影响其决策的因素的认识。
