New advice seeks to prevent parent/doctor conflict in paediatrics

We issue advice to healthcare professionals in light of high profile cases.

While disagreement with the management of a child’s healthcare is rare, when it does happen it can have profound effects on the child, their family and health professionals.

The number of children living with complex and/or life limiting conditions is continuing to rise as advanced forms of life sustaining treatment become available. There is also a large amount of information online about innovative but unproven treatments for serious illnesses which increases the likelihood of conflict in paediatric practice.

Achieving Consensus: advice for paediatricians and other health professionals on prevention, recognition and management of conflict in paediatric practice suggests practices which aim to support professionals to identify and reduce disharmony whilst maintaining the child’s best interest.

Lead author and Registrar of the Royal College of Paediatrics and Child Health (RCPCH), Dr Mike Linney, said:

Health professionals have to make decisions every day about treatment: some routine and some more emotive and complex. These decisions, which always have the child’s best interests at heart, are made alongside the family, but in a very small number of cases, doctors and families disagree.

Conflict is physically and mentally damaging for everyone involved, and in recent years, as cases are propelled into the public domain, further complexity is added to an already sensitive and stressful situation.

This new document, for the first time, brings together practices covering prevention, recognition and management of situations where conflict exists, to support healthcare professionals either prevent disharmony, or manage it. It suggests:

Preventative management

  • Avoiding giving inappropriate expectations to families
  • Using palliative care teams early, not just for end of life care but when treatment options are being discussed
  • Providing access to psychological support to families but also health professionals involved with the child’s care
  • Assigning a Lead Clinician to be responsible for the overall care of the child, including to act as a liaison between family and medical teams, to help ensure messages given to families are clear and consistent, and acknowledging a family’s understanding and expectations and if misunderstanding develops

Identifying conflict

  • Clinical teams must be able to spot the early signs of conflict including: communication breakdown, parents and health professionals avoiding each other, parents feeling they need to oversee or review every aspect of care

Early management

  • Seeking expert ethical and legal advice and considering early involvement of mediation services.

Dr Mike Linney continues:

Due to changing shift patterns, families can see several different professionals, and as a result sometimes receive conflicting information – this is contributory factor of conflict. Assigning a Lead Clinician will be a very effective way of preventing these disputes and so too will instructing mediation services much earlier.

The Achieving consensus advice also provides information on conflict escalation - seeking a second opinion from an independent expert or arranging behavioural and communication contracts - in addition to media management.

Dr Linney said:

It is important families are supported to understand the possible effect media exposure could have on their personal lives and if media attention is sparked, health professionals must consider how actions such as public demonstrations can impact on daily clinical care as well as their own personal health and wellbeing.

A conflict management framework helps recognise and de-escalate conflict in paediatric practice as demonstrated by a pilot in a children’s hospital in Perth. Incidents dropped by 64%. See the study in full in Archives of Disease in Childhood.