All ETDs from UAB

Advisory Committee Chair

Jeffrey M Clair

Advisory Committee Members

Kristine R Hearld

Belinda Needham

Irena Stepanikova

Nancy Tofil

Marjorie L White

Document Type

Dissertation

Date of Award

2014

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

In this dissertation, I utilized a primarily qualitative mixed methods longitudinal process to explore physician-parent pediatric end-of-life communication. Between August 2011 and March 2012, participant pediatric physicians (N=21) from emergency medicine (PEM) and critical care (PCC) were presented with a standardized case of an 8 year-old child in respiratory distress who had a degenerative neurological disorder and was nearing the end-of-life. Participants were observed in a timed simulation experience and given a physician-parent participatory communication score. All simulations were followed by a post-simulation debriefing interview. Then, between March and October 2012, a total of 17 of the original 21 participants then took part in Phase II individual narrative interviews to discuss how their stories informed their approaches to pediatric EOL communication. Finally, between April and June of 2013, all 17 participants from Phase II took part in Phase III narrative interviews, to discuss topics generated out of the data from Phase II. Phase I quantitative results show that women (as opposed to men), fellows (as opposed to attendings), PEM physicians (as opposed to PCC physicians), and parents (as opposed to non-parents) scored higher on the measure of physician-parent participatory communication. Simulation sessions were longer for participants who were male (as opposed to female), PEM physicians (as opposed to PCC physicians), attendings (as opposed to fellows), and parents (as opposed to non-parents). Qualitative data was analyzed using Atlas.ti version 7, according to the guidelines of grounded theory. Qualitative findings indicate that individual physician characteristics emerging from their narratives, particularly those related to religion, parental status, experience level and early experience with death, influence physician-parent EOL interactions. As physicians struggle to find strategies to improve EOL interactions, they realize that their own stories affect their approaches. I propose that a communicative ethic could serve as a foundation for training pediatric physicians to be more effective communicators to promote better care for patients and more positive interactions with caregivers, as well as diminish their own emotional and moral distress.

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