Article Text
Abstract
The relationship between parents and clinician is critical to the care and treatment of children with life-limiting conditions (LLCs) and life-threatening illnesses (LTIs). This relationship is built and maintained largely in consultations. In this article we lay out factors that bear on the success of clinical consultations and the maintenance of the essential clinician–parent relationship at progression or deterioration of LLCs or LTIs. We suggest an approach to engaging parents in conversations about care and treatment that recognises and appreciates the dilemmas which clinicians and parents face and in so doing provides a way for everyone to live with the decisions that are made. A close analysis of a consultation at progression and excerpts of encounters among parents, clinician and researcher are used to illustrate our approach to research, analysis and development of recommendations for clinical practice.
- Oncology
- Qualitative research
- Decision-making
- Communication
- Cystic Fibrosis
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Footnotes
Contributors MB-L, DH, EMH and RL have made substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. MB-L, DH, EMH and RL have been involved in drafting the work or revising it critically for important intellectual content. MB-L, DH and EMH and RL have approved of the version submitted for review. MB-L, DH, EMH and RL have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding The research for the case presented in this paper (Figure 1) was supported by the Health Foundation [grant number 7211]. MB-L's post is funded by the True Colour's Trust. DH's post is funded by the National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London. EH's post is funded by the Louis Dundas Centre Programme Grant.
Competing interests None.
Ethics approval Each study mentioned was approved by the appropriate ethical review committees of the institutions where the research was conducted. All clinicians, parents and where appropriate patients agreed to participate.
Provenance and peer review Commissioned; externally peer reviewed.