Disagreements about paediatric treatment: an exploration of the causes of conflict between parents and clinicians and pathways to dispute resolution

ABSTRACT Conflicts over the care of children with life-limiting conditions can reach the point where courts need to intervene, which brings distress, unwanted media attention and costs. Although no case has arisen in Scotland, there are around 16,700 children with life-limiting conditions (ChiSP3 2020) where care decisions are required and where parents might disagree with clinicians. This study sought to understand reasons for disputes, identify potential solutions and ultimately reduce the risk of court cases arising in Scotland. In-depth interviews with 20 participants from the area covered by NHS Grampian (13 clinicians and 7 parents) were conducted and qualitative data were obtained on their experiences and views on disagreements about care, how decision-making is handled, what works well and what can be improved. Both clinicians and parents agreed that the impact and costs of disagreements are detrimental, that they share a desire to avoid conflict, and that important measures towards avoiding disputes have already been taken. However, there are also disparities in their perceptions of measures designed to support families and avoid conflict. The findings show that there are ways to minimise the incidence of intractable disputes and we recommend their implementation.