Objectives:We sought to characterize sources of pediatric intensive care unit (PICU) conflict, and whether clinicians agree about when and how to implement shared decision-making (SDM) in conflicts.Study Design: This national, multi-center, prospective mixed methods study surveyed 120 physician and nurse PICU directors.Chi-square and Fisher's exact test tested differences by respondent characteristics.Dependent variables were mediation techniques, escalation reasons, interventions for imposing limits, and behavior contract use.Content analysis was used for qualitative data.Results: Of 120 invited leaders (98 physician directors, 22 nurse directors), 68 responded (59 physicians, 9 nurses).After excluding surveys <30% complete, 60 surveys were included in the analysis.Respondent and institutional characteristics varied.PICU sizes were evenly distributed.There was less agreement on how to address conflict in cases where existing pediatric decision-making frameworks would recommend overriding caregiver preferences to prevent serious harm.Those with more clinical experience were less likely to escalate conflicts.Those at larger institutions were more likely to report conflict policies.Conclusions: PICU conflict sources are variable, and leaders' approaches differed based on experience, decision type, and conflict type.We present a descriptive account of approaches to managing conflict for future testing and implementation.Resources tailored to conflicts that are predisposed to disagreements may decrease conflict incidence and improve management, thereby improving patient and caregiver outcomes, moral distress, and burnout for clinical teams. What's New:We present a descriptive account of conflict sources and approaches to managing conflict from the perspectives of pediatric intensive care unit multidisciplinary leaders.We summarize conflict types that were most associated with disagreements, which may benefit most from future intervention.
Olszewski et al. (Wed,) studied this question.