title: End-of-life care decisions in the PICU: roles professionals play.
abstract: OBJECTIVE
  Describe the roles and respective responsibilities of PICU healthcare professionals in end-of-life care decisions faced by PICU parents.
  
  
  METHODS
  Retrospective qualitative study.
  
  
  METHODS
  University-based tertiary care children's hospital.
  
  
  METHODS
  Eighteen parents of children who died in the pediatric ICU and 48 PICU healthcare professionals (physicians, nurses, social workers, child-life specialists, chaplains, and case managers).
  
  
  METHODS
  In depth, semi-structured focus groups and one-on-one interviews designed to explore experiences in end-of-life care decision making.
  
  
  RESULTS
  We identified end-of-life care decisions that parents face based on descriptions by parents and healthcare professionals. Participants described medical and nonmedical decisions addressed toward the end of a child's life. From the descriptions, we identified seven roles healthcare professionals play in end-of-life care decisions. The family supporter addresses emotional, spiritual, environmental, relational, and informational family needs in a nondirective way. The family advocate helps families articulate their views and needs to healthcare professionals. The information giver provides parents with medical information, identifies decisions or describes available options, and clarifies parents' understanding. The general care coordinator helps facilitate interactions among healthcare professionals in the PICU, among healthcare professionals from different subspecialty teams, and between healthcare professionals and parents. The decision maker makes or directly influences the defined plan of action. The end-of-life care coordinator organizes and executes functions occurring directly before, during, and after dying/death. The point person develops a unique trusting relationship with parents.
  
  
  CONCLUSIONS
  Our results describe a framework for healthcare professionals' roles in parental end-of-life care decision making in the pediatric ICU that includes directive, value-neutral, and organizational roles. More research is needed to validate these roles. Actively ensuring attention to these roles during the decision-making process could improve parents' experiences at the end of a child's life.
authors.affiliation: Division of Critical Care Medicine, Children's Memorial Hospital, Northwestern University, Chicago, IL, USA. kmichelson@childrensmemorial.org
authors.forename: Kelly Nicole
authors.initials: KN
authors.lastname: Michelson
authors.forename: Rachna
authors.initials: R
authors.lastname: Patel
authors.forename: Natalie
authors.initials: N
authors.lastname: Haber-Barker
authors.forename: Linda
authors.initials: L
authors.lastname: Emanuel
authors.forename: Joel
authors.initials: J
authors.lastname: Frader
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002977:Clergy; D003142:Communication; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006282:Health Personnel; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010290:Parents; D010347:Patient Care Planning; D024382:Professional Role; D012189:Retrospective Studies; D012947:Social Work; D013727:Terminal Care; D055815:Young Adult