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Achieving consensus advice for paediatricians and other health professionals: on prevention, recognition and management of conflict in paediatric practice
  1. Mike Linney1,2,
  2. Richard D W Hain3,
  3. Dominic Wilkinson4,5,
  4. Peter-Marc Fortune6,
  5. Sarah Barclay7,
  6. Vic Larcher8,
  7. Jacqueline Fitzgerald2,
  8. Emily Arkell2
  1. 1 Women and Childrens, Western Sussex Hospitals NHS Foundation Trust, Worthing, West Sussex, UK
  2. 2 Royal College of Paediatrics and Child Health, London, UK
  3. 3 All-Wales Paediatric Palliative Care Network, Noah’s Ark Children’s Hospital for Wales, Cardiff, UK
  4. 4 Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
  5. 5 Newborn care unit, John Radcliffe Hospital, Oxford, UK, Oxford, UK
  6. 6 Paediatric Intensive Care Unit, Royal Manchester Children’s Hospital, Manchester, Manchester, UK
  7. 7 Medical Mediation Foundation, London, UK
  8. 8 Honorary Consultant in Bioethics, Great Ormond Street Hospital For Children NHS Trust, London, UK
  1. Correspondence to Dr Mike Linney, Women And Childrens, Western Sussex Hospitals NHS Foundation Trust, Worthing PO19 6SE, UK; mike.linney{at}wsht.nhs.uk

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Introduction

Conflict can arise between health professionals and the parents of children not only where there is disagreement on the withdrawal or withholding of life sustaining treatment, as seen in recent high-profile cases1 2 but also in more general routine care. In this paper we attempt to suggest practices which may reduce disharmony. Although, many of you will already incorporate such practices in your daily working lives, we felt it useful to collate this guidance covering prevention, recognition and management of situations when conflict clearly exists. It will not resolve all conflicts and clearly there will be other practices which are helpful but are not mentioned here, similarly there are further reflections needed on recent cases3 There is limited research in this field so we have taken evidence from clinicians, parents, parent advocates, ethicists and mediators of conflict in writing this document. As healthcare professionals involved in the care of children and young people, every decision we take will always have the best interests of the child at heart. Decisions on care, including the withdrawal of treatment, as far as is possible, should always be made with the involvement of parents. In the majority of cases in these decisions are made jointly by parents and clinicians.4

However, disagreements leading to conflict can sometimes develop between professionals and families in the context of critical illness both in children and adults.5 6 End-of-life decision making and communication failure are the common areas of dispute.6 7 Conflict is also prevalent in children’s inpatient wards8 where staff report communication breakdown, disagreements over treatment and unrealistic expectations as the most common causes. A contributor to this may be the fact that the parents and carers of children in hospital report receiving conflicting information from health professionals.9 With this in …

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