Publication
Has Pediatric Palliative Care Become Too Deferential? A Challenge To and For the Field
Humphrey L, Jacobowski N, Truba N · Journal of Pain and Symptom Management · 2024
Outcomes: 1. Utilizing a case-based approach plus content expert didactic presentation, participants will self-report ability to identify 3 defensive mechanisms utilized by caregivers and providers during shared decision making (SDM) that can compromise its outcome. 2. Utilizing content expert didactic presentation and a case-based approach, participants will self-report ability to articulate strategies to survey for and engage in defense mechanisms when engaged in value-based decision making with caregivers. Key Message: Pediatrics is posited upon family centered care. Pediatric Palliative Care seeks to elucidate values and ensure goal concordant care within this dynamic. Yet, does radical acceptance equal agreement with a medical decision and should Pediatric Palliative Care always champion a caregiver request? This session explores this question and if the field needs a course correction. Objective(s): 1. Participants will identify at least 3 defensive mechanisms utilized by caregivers and providers during shared decision making that can compromise its outcome. 2. Participants will be able to discern a caregiver's desired outcome from their values and how their conflation can lead to discordant caregiver decision making. 3. Participants will identify at least 2 healthcare provider strategies to use during shared decision making to optimize value-based decision making. This presentation will utilize slide presentation, expert opinion, and clinical vignettes to review perceived changes over the past decade in how pediatric palliative care (PPC) specialists engage with caregiver decision making regarding medical interventions. It will challenge participants to consider that the field is increasingly teaching and practicing alignment with families via validation is a primary objective rather than our historic focus on actively guiding a decision-making process through value alignment. Pediatrics' emphasis on family-centered decision-making challenges PPC providers by inadvertently increasing caregiver decisional-stress and fatigue, which induces reliance on pre-existing coping skills and psychological defense mechanisms to navigate their distress. This reliance risks PPC provider alignment with decisions rather than values, and as many of these defense mechanisms are in the higher functioning range of defense mechanisms, they are more challenging to detect and address. These concepts will be explored by a palliative psychiatrist and palliative psychologist as well as strategies PPC providers can deploy to identify some of these barriers and to better engage with patients and families to optimize value-based decision making. Keywords: Shared Decision Making / Advance Care Planning; Interdisciplinary Teamwork / ProfessionalismCopyright © 2024
Synced from the TRENDS in Pediatric Palliative Care Zotero library, curated by The Siden Research Team. ICPCN does not host or verify the full text.