Elliott Mark Weiss|Dawei Xie|Noah Cook|Katherine Coughlin|Steven Joffe
Characteristics Associated With Preferences for Parent-Centered Decision Making in Neonatal Intensive Care
Seattle Children's Hospital|University of Washington|University of Pennsylvania|Pennsylvania Hospital|Children's Hospital of Philadelphia|Children's Hospital of Philadelphia|University of Pennsylvania
little known characteristics particular clinical decisions influence decisionmaking preferences patients surrogates better understanding factors underlying preferences essential improve quality shared decision makingto identify characteristics particular decisions associated parents preferences family vs medical teamcentered decision making across spectrum clinical decisions arise neonatal intensive care unit nicuthis crosssectional survey assessed parents preferences parent vs medical teamcentered decision making across 16 clinical decisions along parents assessments 7 characteristics decisions respondents included 136 parents infants 1 3 academically affiliated hospital nicus philadelphia pennsylvania january 7 july 8 2016 respondents represented wide range educational levels employment status household income predominantly female 109 801 white 68 500 african american 53 390 married 81 132 responding 614preferences parentcentered decision making decision characteristic eg urgency multivariable analyses tested whether middle high levels characteristic compared low levels associated preference parentcentered decision making resulting 2 odds ratios ors per decision characteristicamong 136 respondents 109 women 801 27 men 199 median age 30 years range 1843 years preferences parentcentered decision making positively associated decisions involved bigpicture goals middle 201 99 ci 083486 high 338 99 ci 148775 potential harm infant middle 132 99 ci 084208 high 262 99 ci 167411 contrast preferences parentcentered decision making inversely associated following 4 decision characteristics technical decisions middle 082 99 ci 045152 high 048 99 ci 025093 potential benefit infant middle 042 99 ci 016105 high 021 99 ci 008052 requires medical expertise middle 048 99 ci 022105 high 021 99 ci 010048 high level urgency middle 047 99 ci 024092 high 042 99 ci 022083preferences parentcentered vs medical teamcentered decision making among parents infants nicu may vary systematically characteristics particular clinical decisions incorporating variation shared decision making endorsing models allow parents cede control physicians appropriate clinical circumstances might improve quality outcomes medical decisions