"What would you do if this were your child?" : Practitioners' responses during enacted conversations in the United States

OBJECTIVE: To explore how practitioners in the United States respond to the question "What would you do if this were your child?" during realistic enactments with professional actors. DESIGN: Descriptive study of realistic pediatric critical care enactments. SETTING: Pediatric critical care. SUBJECTS: Interprofessional practitioners who enrolled in the Program to Enhance Relational and Communication Skills at Children's Hospital Boston and engaged in realistic simulated enactments. INTERVENTION: During the Program to Enhance Relational and Communication Skills workshops, practitioners met with parent-actors faced with life-support decisions for their 5-yr-old son who had suffered a near-drowning incident. Parent-actors were directed to naturally pose the question, "What would you do if this were your child?" The enactments were videotaped and practitioners' verbal responses to the question were qualitatively analyzed using content analysis. MEASUREMENTS AND MAIN RESULTS: From 2003 to 2008, we offered 20 Program to Enhance Relational and Communication Skills workshops and analyzed 20 realistic enactments during which interprofessional teams engaged in conversations about life-support decisions with parent-actors. In 50% of the meetings, the physician responded to the question, in 25% both the physician and the nurse or social worker, in 20% the nurse, and in 5% the physical therapist. The content of practitioners' responses yielded six themes: acknowledgment; discomfort and/or reluctance; values and decision-making approaches; focus on medical information; emotional and practical support; and personal response and self-disclosure. Eighty percent of practitioners' responses included more than one theme. CONCLUSIONS: Practitioners demonstrated a wide repertoire of responses that varied in their degree of relational engagement and responsiveness. Future research should explore parents' perspectives and preferences regarding such communication to further refine recommendations and educational experiences.