Parental Explicit Heuristics in Decision-making for Children With Life-threatening Illnesses
Chris B. Renjilian, James W. Womer, Karen W. Carroll, Tammy I. Kang and Chris Feudtner
Pediatrics February 2013, 131 (2) e566-e572; DOI: https://doi.org/10.1542/peds.2012-1957
Chris B. Renjilian
aPediatric Advanced Care Team,
bPediatric Residency Training Program,
James W. Womer
cDepartment of Medical Ethics,
Karen W. Carroll
Tammy I. Kang
dDivision of Oncology, and
Chris Feudtner
ePolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
OBJECTIVE: To identify and illustrate common explicit heuristics (decision-making aids or shortcuts expressed verbally as terse rules of thumb, aphorisms, maxims, or mantras and intended to convey a compelling truth or guiding principle) used by parents of children with life-threatening illnesses when confronting and making medical decisions.
METHODS: Prospective cross-sectional observational study of 69 parents of 46 children who participated in the Decision-making in Pediatric Palliative Care Study between 2006 and 2008 at the Children's Hospital of Philadelphia. Parents were guided individually through a semistructured in-depth interview about their experiences and thoughts regarding making medical decisions on behalf of their ill children, and the transcribed interviews were qualitatively analyzed.
RESULTS: All parents in our study employed explicit heuristics in interviews about decision-making for their children, with the number of identified explicit heuristics used by an individual parent ranging from tens to hundreds. The heuristics served 5 general functions: (1) to depict or facilitate understanding of a complex situation; (2) to clarify, organize, and focus pertinent information and values; (3) to serve as a decision-making compass; (4) to communicate with others about a complex topic; and (5) to justify a choice.
CONCLUSIONS: Explicit heuristics played an important role in decision-making and communication about decision-making in our population of parents. Recognizing explicit heuristics in parent interactions and understanding their content and functions can aid clinicians in their efforts to partner with parents in the decision-making process.
Copyright © 2013 by the American Academy of Pediatrics
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Chris B. Renjilian, James W. Womer, Karen W. Carroll, Tammy I. Kang, Chris Feudtner
Pediatrics Feb 2013, 131 (2) e566-e572; DOI: 10.1542/peds.2012-1957
Parental Personal Sense of Duty as a Foundation of Pediatric Medical Decision-making
Ethics/Bioethics
Administration/Practice Management