Decision-making dilemmas of paediatricians: A qualitative study in Japan

Momoko Sasazuki, Yasunari Sakai, Ryutaro Kira, Naoko Toda, Yuko Ichimiya, Satoshi Akamine, Michiko Torio, Yoshito Ishizaki, Masafumi Sanefuji, Miho Narama, Koichiro Itai, Toshiro Hara, Hidetoshi Takada, Yoshiyuki Kizawa, Shouichi Ohga

研究成果: ジャーナルへの寄稿記事

抄録

Objective To delineate the critical decision-making processes that paediatricians apply when treating children with life-threatening conditions and the psychosocial experience of paediatricians involved in such care. Design We conducted semistructured, individual face-to-face interviews for each participant from 2014 to 2015. The content of each interview was subjected to a comprehensive qualitative analysis. The categories of dilemma were extracted from a second-round content analysis. Participants Participants were board-certified paediatricians with sufficient experience in making decisions in relation to children with severe illnesses or disabilities. We repeated purposive sampling and analyses until we reached saturation of the category data. Results We performed interviews with 15 paediatricians. They each reported both unique and overlapping categories of dilemmas that they encountered when making critical decisions. The dilemmas included five types of causal elements: (1) paediatricians' convictions; (2) the quest for the best interests of patients; (3) the quest for medically appropriate plans; (4) confronting parents and families and (5) socioenvironmental issues. Dilemmas occurred and developed as conflicting interactions among these five elements. We further categorised these five elements into three principal domains: the decision-maker (decider); consensus making among families, colleagues and society (process) and the consequential output of the decision (consequence). Conclusions This is the first qualitative study to demonstrate the framework of paediatricians' decision-making processes and the complex structures of dilemmas they face. Our data indicate the necessity of establishing and implementing an effective support system for paediatricians, such as structured professional education and arguments for creating social consensus that assist them to reach the best plan for the management of severely ill children.

元の言語英語
記事番号e026579
ジャーナルBMJ open
9
発行部数8
DOI
出版物ステータス出版済み - 8 1 2019

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Decision Making
Japan
Interviews
Consensus
Professional Education
Pediatricians
Parents

All Science Journal Classification (ASJC) codes

  • Medicine(all)

これを引用

Decision-making dilemmas of paediatricians : A qualitative study in Japan. / Sasazuki, Momoko; Sakai, Yasunari; Kira, Ryutaro; Toda, Naoko; Ichimiya, Yuko; Akamine, Satoshi; Torio, Michiko; Ishizaki, Yoshito; Sanefuji, Masafumi; Narama, Miho; Itai, Koichiro; Hara, Toshiro; Takada, Hidetoshi; Kizawa, Yoshiyuki; Ohga, Shouichi.

:: BMJ open, 巻 9, 番号 8, e026579, 01.08.2019.

研究成果: ジャーナルへの寄稿記事

Sasazuki, M, Sakai, Y, Kira, R, Toda, N, Ichimiya, Y, Akamine, S, Torio, M, Ishizaki, Y, Sanefuji, M, Narama, M, Itai, K, Hara, T, Takada, H, Kizawa, Y & Ohga, S 2019, 'Decision-making dilemmas of paediatricians: A qualitative study in Japan', BMJ open, 巻. 9, 番号 8, e026579. https://doi.org/10.1136/bmjopen-2018-026579
Sasazuki, Momoko ; Sakai, Yasunari ; Kira, Ryutaro ; Toda, Naoko ; Ichimiya, Yuko ; Akamine, Satoshi ; Torio, Michiko ; Ishizaki, Yoshito ; Sanefuji, Masafumi ; Narama, Miho ; Itai, Koichiro ; Hara, Toshiro ; Takada, Hidetoshi ; Kizawa, Yoshiyuki ; Ohga, Shouichi. / Decision-making dilemmas of paediatricians : A qualitative study in Japan. :: BMJ open. 2019 ; 巻 9, 番号 8.
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abstract = "Objective To delineate the critical decision-making processes that paediatricians apply when treating children with life-threatening conditions and the psychosocial experience of paediatricians involved in such care. Design We conducted semistructured, individual face-to-face interviews for each participant from 2014 to 2015. The content of each interview was subjected to a comprehensive qualitative analysis. The categories of dilemma were extracted from a second-round content analysis. Participants Participants were board-certified paediatricians with sufficient experience in making decisions in relation to children with severe illnesses or disabilities. We repeated purposive sampling and analyses until we reached saturation of the category data. Results We performed interviews with 15 paediatricians. They each reported both unique and overlapping categories of dilemmas that they encountered when making critical decisions. The dilemmas included five types of causal elements: (1) paediatricians' convictions; (2) the quest for the best interests of patients; (3) the quest for medically appropriate plans; (4) confronting parents and families and (5) socioenvironmental issues. Dilemmas occurred and developed as conflicting interactions among these five elements. We further categorised these five elements into three principal domains: the decision-maker (decider); consensus making among families, colleagues and society (process) and the consequential output of the decision (consequence). Conclusions This is the first qualitative study to demonstrate the framework of paediatricians' decision-making processes and the complex structures of dilemmas they face. Our data indicate the necessity of establishing and implementing an effective support system for paediatricians, such as structured professional education and arguments for creating social consensus that assist them to reach the best plan for the management of severely ill children.",
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AU - Sasazuki, Momoko

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AU - Kira, Ryutaro

AU - Toda, Naoko

AU - Ichimiya, Yuko

AU - Akamine, Satoshi

AU - Torio, Michiko

AU - Ishizaki, Yoshito

AU - Sanefuji, Masafumi

AU - Narama, Miho

AU - Itai, Koichiro

AU - Hara, Toshiro

AU - Takada, Hidetoshi

AU - Kizawa, Yoshiyuki

AU - Ohga, Shouichi

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