title: The parent perspective: "being a good parent" when making critical decisions in the PICU.
abstract: OBJECTIVE
  To identify factors important to parents making decisions for their critically ill child.
  
  
  METHODS
  Prospective cross-sectional study.
  
  
  METHODS
  Single center, tertiary care PICU.
  
  
  METHODS
  Parents making critical treatment decisions for their child.
  
  
  METHODS
  One-on-one interviews that used the Good Parent Tool-2 open-ended question that asks parents to describe factors important for parenting their ill child and how clinicians could help them achieve their definition of "being a good parent" to their child. Parent responses were analyzed thematically. Parents also ranked themes in order of importance to them using the Good Parent Ranking Exercise.
  
  
  RESULTS
  Of 53 eligible parents, 43 (81%) participated. We identified nine themes through content analysis of the parent's narrative statements from the Good Parent Tool. Most commonly (60% of quotes) components of being a good parent described by parents included focusing on their child's quality of life, advocating for their child with the medical team, and putting their child's needs above their own. Themes key to parental decision making were similar regardless of parent race and socioeconomic status or child's clinical status. We identified nine clinician strategies identified by parents as helping them fulfill their parenting role, most commonly, parents wanted to be kept informed (32% of quotes). Using the Good Parent Ranking Exercise, fathers ranked making informed medical decisions as most important, whereas mothers ranked focusing on the child's health and putting their child's needs above their own as most important. However, mothers who were not part of a couple ranked making informed medical decisions as most important.
  
  
  CONCLUSIONS
  These findings suggest a range of themes important for parents to "be a good parent" to their child while making critical decisions. Further studies need to explore whether clinician's knowledge of the parent's most valued factor can improve family-centered care.
authors.affiliation: 1Department of Critical Care Medicine, Children's National Medical Center, Washington, DC. 2Department of Pediatrics, George Washington University School of Medicine, Washington, DC. 3Department of Medical Ethics and Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, PA. 4Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 5Department of Nursing Research and Quality Outcomes, Children's National Medical Center, Washington, DC.
authors.forename: Tessie W
authors.initials: TW
authors.lastname: October
authors.forename: Kiondra R
authors.initials: KR
authors.lastname: Fisher
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Hinds
mesh_terms: D000328:Adult; D002648:Child; D002651:Child Advocacy; D002675:Child, Preschool; D003142:Communication; D016638:Critical Illness; D003430:Cross-Sectional Studies; D003657:Decision Making; D005220:Fathers / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009035:Mothers / Q000523:psychology*; D010344:Patient Advocacy; D011446:Prospective Studies; D036301:Qualitative Research; D011788:Quality of Life