Decisions to forgo life-sustaining medical treatment in a Canadian paediatric critical care unit (PCCU) : maternal perception of subsequent family adjustment

Votta, Elizabeth Anne (1995) Decisions to forgo life-sustaining medical treatment in a Canadian paediatric critical care unit (PCCU) : maternal perception of subsequent family adjustment. Masters thesis, Memorial University of Newfoundland.

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Abstract

Maternal perception of family adjustment following three types of decisions regarding a child's life-sustaining medical treatment was evaluated. Participants were mothers whose: child died following a discussion to forgo life-support (n = 18); child died, but a discussion to forgo life-support did not occur (n = 6); and child survived despite the fact that a member of the medical staff felt a discussion to forgo life-support should have occurred (n = 16). A fourth group of mothers of chronically ill children (n = 106) visiting the hospital's out-patient clinics was included as a comparison group for a family functioning measure. Groups differed significantly in family functioning; Group 1 families were marginally less cohesive and adaptable than families in Groups 2, 3 and 4. Mothers did not differ in their perception of the hospital decision-making experience, nor stress arising from the Pediatric Critical Care Unit (PCCU). With respect to maternal psychological symptom status, mothers in Group 2 exhibited a more intense symptom pattern than did mothers in Group 3, who in turn exhibited a more intense pattern than mothers in Group 1. Maternal ratings of siblings behaviours differed significantly, siblings in Group 1 were rated as exhibiting fewer internalizing and externalizing behaviour problems than siblings in Groups 2 and 3. Although not correlated with maternal psychological symptomatology, family functioning correlated with the number of positive mother-child interactions. The intensity of maternal psychological symptom status correlated with maternal perceptions of total PCCU stress and behaviour problems exhibited by siblings. Implications of the PCCU experience and decisions to forgo life-support on family adjustment are discussed.

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