“In The Room Where It Happens”: Understanding the interplay of interdisciplinary teams dynamics in complex ethical decision-making in the NICU
Friday, October 13, 2023
8:00 AM – 9:15 AM ET
Location: Bristol (Third Floor)
The parent-physician dyad has primarily been the focus of ethical research on shared decision-making in the NICU. But as those familiar with this complex care environment know, multiple stakeholders are invested in these decisions. In our paper, we will present our design and findings from our qualitative study that explores how NICU healthcare professionals (HCP) of diverse disciplines navigate and cope with complex ethical decisions surrounding parental request for continued interventions in the case of prognostic uncertainty vs. potentially inappropriate treatment. Using focus groups (FG) and interviews, NICU HCP (including attendings, fellows, nurses, nurse practitioners, social workers, case managers, child life specialists, and ethics/palliative care consultants) were asked to review a hypothetical case of a patient with severe neurological impairment from hypoxic ischemic encephalopathy. Each FG received the same medical information but were randomized to 2 different cases where the social context of the family varied .
Our aims were to understand (1) how HCP individually and collectively make decisions in these complex cases, (2) the role of non-clinical data in influencing treatment decisions; (3) what power differentials/dynamics exist and whose voices matter most; and (4) how concepts of justice, best interest, and moral distress arise within interdisciplinary ethical decision-making.
We will share our in-progress analysis, exploring several major themes including opinions on best interest, justice, parental involvement/choice, and shared decision-making as well as perspectives on communication, trust, and secondary trauma. We also discuss next steps to expand upon this work and compare to the perspectives of former NICU parents.
Carey DeMichelis, PhD – Assistant Professor, Psychology, University of the Fraser Valley; Elizabeth Lanphier, PhD, MS, HEC-C – Assistant Professor, Ethics Center, Cincinnati Children’s Hospital Medical Center; Uchenna Anani, MD – Assistant Professor of Clinical Pediatrics, Pediatrics/Neonatology, Vanderbilt University Medical Center