Reactions of pediatricians to refusals of medical treatment for minors

The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine
Erin D TalatiLainie Friedman Ross

Abstract

Treatment refusals in pediatrics must balance parental decision-making authority and best interest. General pediatricians and subspecialists were surveyed to understand the factors that influence their responses to refusals including (1) prognosis, (2) concordance of parent-minor decision, and (3) minor autonomy. Of 1,120 eligible pediatricians, 421 (37.6%) randomly selected from the American Academy of Pediatrics Web-based Directory completed a survey about their reactions to refusals of treatment by parents, minors, or both in cancer scenarios with a 5-year expected overall survival of 80% or 15% for both an 11-year-old and a 16-year-old minor. Statistical analyses compared pediatrician willingness to respect a refusal and the relative importance of various factors to explain physician reasoning. Pediatricians were less likely to respect refusals when prognosis was good. Pediatricians were most likely to respect a refusal when prognosis was poor and when parent and minor concurred in their decision (93%, n = 360/385 for the 16-year-old vs. 89%, n = 345/386 for the 11-year-old, p < .05). When parent-minor dyad disagreed, pediatricians were more likely to accept a refusal by a 16-year-old minor as compared with an 11-year-old (...Continue Reading

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Citations

Sep 29, 2011·Journal of Paediatrics and Child Health·Angela J Alessandri
Jul 20, 2010·The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine·Rony E Duncan, Susan M Sawyer
Aug 19, 2015·The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine·Pierre-André MichaudValentina Baltag
Jan 27, 2016·Journal of Adolescent and Young Adult Oncology·Elizabeth J Siembida, Keith M Bellizzi
Nov 21, 2014·Journal of Pediatric Hematology/oncology·Michele L NassinPaul M Kent
Sep 23, 2016·Journal of Bioethical Inquiry·Vida JeremicDanya F Vears
Oct 18, 2020·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Rajeev D SenJason S Hauptman
Feb 16, 2021·Pediatric Pulmonology·Emily E BarskyRobert D Truog

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