Parental hopeful patterns of thinking, emotions, and pediatric palliative care decision making: a prospective cohort study.
OBJECTIVE
To test the hypothesis that hopeful patterns of thoughts and emotions of parents of pediatric patients receiving palliative care consultative services are related to subsequent decisions, specifically regarding limit of intervention (LOI) orders.


METHODS
Prospective cohort study.


METHODS
Children's hospital and surrounding region.


METHODS
Thirty-three pediatric patients receiving palliative care consultative services who did not have LOI orders at time of cohort entry and their 43 parental adults.


METHODS
Parental levels at time of cohort entry of hopeful patterns of thinking and emotions, in conjunction with perceptions about patients' health trajectories.


METHODS
Enactment of an LOI order after entry into the cohort.


RESULTS
During the 6 months of observation, 14 patients (42.4%) had an LOI order enacted. In adjusted analyses, higher levels of parental hopeful patterns of thinking were significantly associated with increased odds of enactment of an LOI order (adjusted odds ratio [AOR], 2.73; 95% confidence interval [CI], 1.04-7.22). Increased odds of LOI enactment were associated to nonsignificant degrees with lower levels of parental positive affect (AOR, 0.44; 95% CI, 0.17-1.12), higher levels of parental negative affect (AOR, 2.02; 95% CI, 0.98-4.16), and parental perceptions of worsening health over time (AOR, 1.72; 95% CI, 0.73-4.07).


CONCLUSIONS
For pediatric patients receiving palliative care consultative services, higher levels of parents' hopeful patterns of thinking are associated with subsequent enactment of LOI orders, suggesting that emotional and cognitive processes have a combined effect on medical decision making.
Feudtner
Chris
C
General Pediatrics, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104. USA. feudtner@email.chop.edu
Carroll
Karen W
KW
Hexem
Kari R
KR
Silberman
Jordan
J
Kang
Tammy I
TI
Kazak
Anne E
AE
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D004644:Emotions; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010166:Palliative Care / Q000523:psychology*; D010290:Parents / Q000523:psychology; D011446:Prospective Studies; D013850:Thinking
Cardiol Young. 2009 Dec;19(6):608-14
19825253
Pediatrics. 2007 Jan;119(1):e186-92
17200243
Pediatr Clin North Am. 2007 Oct;54(5):757-71, xi-xii
17933621
J Pers Soc Psychol. 1988 Jun;54(6):1063-70
3397865
J Pers Soc Psychol. 1996 Feb;70(2):321-35
8636885
Arch Pediatr Adolesc Med. 2009 Jul;163(7):653-7
19581549
Pediatrics. 2000 Aug;106(2 Pt 1):351-7
10920167
Science. 1974 Sep 27;185(4157):1124-31
17835457
N Engl J Med. 2004 Apr 22;350(17):1752-62
15103002
Psychol Bull. 1999 Jan;125(1):3-30
9990843
Int J Pediatr Otorhinolaryngol. 2009 Jan;73(1):15-20
19019462
Prog Transplant. 2009 Jun;19(2):122-7
19588661
Psychol Bull. 2001 Mar;127(2):267-86
11316014
Child Care Health Dev. 2009 Sep;35(5):673-80
19320906
Lancet. 2008 Mar 8;371(9615):852-64
17707080
J Pers Soc Psychol. 1991 Apr;60(4):570-85
2037968
Psychooncology. 2005 Apr;14(4):262-73
15386769
J Fam Psychol. 2007 Sep;21(3):407-15
17874926
BMJ. 2009 Jun 29;338:b2393
19564179
Soc Sci Med. 2000 Jun;50(12):1715-22
10798327
J Altern Complement Med. 2005;11 Suppl 1:S23-30
16332183
Acta Neurol Scand. 2009 Nov;120(5):335-41
19456304
Pers Soc Psychol Bull. 2003 Dec;29(12):1494-508
15018681
J Pers Soc Psychol. 2002 Dec;83(6):1261-80
12500810
Biol Psychol. 2006 Aug;73(2):165-8
16513242
N Engl J Med. 2009 Dec 10;361(24):2306-7
20007559
J Pers Soc Psychol. 1984 Nov;47(5):1105-17
6520704
J Pers Soc Psychol. 1988 Nov;55(5):710-7
3210141
Psychol Rev. 1967 Jan;74(1):29-39
5341441
J Pers. 1998 Apr;66(2):195-214
9529663
J Pediatr Psychol. 2008 Aug;33(7):694-706
18287109