Assessment of physician directiveness: using hypoplastic left heart syndrome as a model.
OBJECTIVE
To test the hypothesis that surgeons are more directive than pediatricians in discussions with parents of critically ill children.


METHODS
We designed a novel tool to assess physician directiveness in discussions with parents of children with hypoplastic left heart syndrome. We sent surveys containing the assessment tool as well as demographic questions to all attending physicians in Neonatology, Pediatric Critical Care, Pediatric Cardiology, and Congenital Cardiac Surgery at 14 of the largest pediatric cardiac surgery centers in the United States. Responses to the tool were used to determine a "directiveness score" for each physician. We then performed univariate and multivariable linear regression analyses to assess the association of physician specialty, race/ethnicity, religion, gender, and years in practice with the directiveness score.


RESULTS
Responses from 138 physicians were analyzed. In univariate analyses, with neonatologists as the reference group, surgeons were most directive (regression coefficient 3.02, 95% confidence interval 0.69 to 5.35, P=0.01), followed by cardiologists (regression coefficient 1.67, 95% confidence interval 0.13 to 3.20, P=0.03). No other variable was associated with physician directiveness score. These results were similar in the multivariable analysis.


CONCLUSIONS
These results suggest that physician specialty is associated with directiveness. It is unclear, however, what amount of direction parents of critically ill children prefer.
Kon
Alexander A
AA
Section of Pediatric Critical Care Medicine and the Program in Bioethics at the University of California Davis, Davis, CA 95817, USA.
D002140:California; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery; D007231:Infant, Newborn; D008297:Male; D008511:Medicine; D010818:Practice Patterns, Physicians'; D011368:Professional-Family Relations; D013038:Specialization