Tracheostomy: An Opportunity for Improved Shared-Decision Making

A tracheostomy is a surgical procedure that involves creating an opening in the neck where a removable breathing tube is inserted to bypass an obstruction and allow for long-term mechanical ventilation. In pediatrics, when a tracheostomy is medically feasible, the decision to undergo the procedure is complex and should involve shared decision-making (SDM) between the medical team and patient’s family. This approach proves to be challenging when conversations are rushed, parents feel pressured to bear the decision burden, or staff follow a paternal decision-making framework. The approach to such a decision should be tailored to the patient and their family, but a standardized method may improve both medical team and family experience.

To promote an improved SDM process regarding a tracheostomy decision, this study examines the current counseling process from the perspective of medical team members and family members/support persons involved. The study methodology includes qualitative analysis of audio recordings of family meetings and electronic surveys of meeting attendees. We hypothesize family meetings will involve more unilateral transfer of information from the medical team to families but aim to improve the bidirectional dialogue necessary for SDM.

Development of a standardized approach to a complex medical decision, such as tracheostomy, ensures staff and families are given the tools and information necessary to communicate effectively and participate in SDM. We will discuss how analysis of family meetings informs further interventions to improve the medical team and family experience.

Rachel Clarke, MD – Assistant Professor, Pediatric Critical Care, SUNY Upstate Medical University; Kerry Ryan, MA – Research Associate, Center for Bioethics and Social Sciences in Medicine, University of Michigan; Kenneth Pituch, MD – Clinical Professor Emeritus, Pediatrics, University of Michigan; Stephanie Kukora, MD – Assistant Professor, Neonatal-Perinatal Medicine, Children's Mercy Kansas City