Background: Whilst disagreement with the management of a child’s healthcare is rare, when it does happen, it can profoundly affect the child, their family and health professionals.
Numbers of children living with complex and/or life-limiting conditions continues to rise as advanced forms of life-sustaining treatment become available. With a large amount of information online about innovative but unproven treatments this increases the likelihood of conflict in paediatric practice. Conflict is physically and mentally damaging for everyone involved, and in recent years, as cases are propelled into the public domain1, further complexity is added to an already sensitive and stressful situation
Objective: Providing advice and helping identify good practice for all paediatric health professionals on achieving consensus in decision making and in avoiding conflict, written on behalf of the Royal College of Paediatrics and Child Health (RCPCH)
Methods: Based on the experiences of health professionals and families, the published article2 is the first to suggest best practices for prevention, recognition, and management of situations where conflict exists. Those consulted included parents of children from intensive care, mediators, ethicists, intensivists, paediatricians, charities for families and children with complex conditions, nursing bodies, lawyers and palliative care specialists.
Results: Amongst the advice given we recommend:
· Assigning a lead clinician to be responsible for the overall care of the child
· Avoiding giving families inappropriate expectations
· Ensuring that communications are clear, consistent and transparent
· Working with palliative care experts early, not just for the end of life care
· Making psychological support available to families and health professionals
· Recognizing disagreements and communication failings early
Conclusion: Conflict is damaging, stressful and emotionally challenging for all involved. Taking the correct early steps may prevent early disagreements from reaching conflict. As the child’s best interest remains paramount the families wish and needs must also be taken into consideration.