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We need to understand the big picture!

Introduction Intensive care units are places where technologically advanced and aggressive treatment is the norm. End-of-life decision making for children in pediatric intensive care units (PICUs) is a complex process both medically and ethically. The author examined providers’ decision-making processes that influence both the technique of conversations and the recommendations given to parents regarding limitation or withdrawal of life sustaining treatments. Methods A qualitative study was conducted in a large PICU. Interview data were analyzed by coding all transcripts and identifying concepts and themes that were then used in the formation of a conceptual framework. This analysis was validated with peer review sessions. Results The author identified four major themes regarding decision-making. They are: Expectations and Perspectives, Communication Enhancers and Inhibitors, Decision Enablers and Barriers, and Conversation Mechanics. Discussion Additional research is needed to fully understand the complex decision making process; however, themes identified suggest interventions that should be explored. Teaching providers’ conversation mechanics and increasing provider comfort with the ethically justifiable component of directive counseling are a few areas to be addressed.