{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:41:55Z","timestamp":1760060515601,"version":"build-2065373602"},"reference-count":54,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Michigan"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Pediatric tracheostomy decisions are challenging for clinicians and parents, especially when a child\u2019s survival\/neurodevelopmental outcome is uncertain. Better understanding of parents\u2019 values over the decision period is crucial for clinical decision-making. Objective: To describe parents\u2019 values during tracheostomy decision-making for their critically ill child and to identify opportunities to improve parent\u2013clinician shared decision-making (SDM). Methods: We thematically analyzed 12 semi-structured interviews with parents who recently faced a tracheostomy decision for their critically ill child. Three study team members with qualitative expertise reviewed the transcripts, identifying key topics independently. A codebook was developed, and data were coded. Key research questions guided analysis, with findings iteratively reviewed by the study team. Results: We identified parents\u2019 values at the three time points: when the decision was introduced, during their deliberations of it, and when the ultimate decision was made. Initially, parents resisted tracheostomy because it threatens normalcy. They valued proof of a need for tracheostomy and information with certainty. As certainty for tracheostomy increased over time, parents\u2019 hope focused on reversibility of tracheostomy and improvement in normalcy compared to current status. They concurrently worried about practical issues such as emergencies, home care, and finances. Key considerations driving the final decision included best interest of the child, perceived benefits of tracheostomy compared to its downsides or other options, and potential for better quality of life and longer life. Conclusions: Parents\u2019 dynamic values shifting with clinical uncertainty suggests opportunities to improve SDM by attending to parents\u2019 individualized needs and managing expectations.<\/jats:p>","DOI":"10.3390\/children12091115","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T06:41:56Z","timestamp":1756104116000},"page":"1115","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Parental Values During Tracheostomy Decision-Making for Their Critically Ill Child: Interviews of Parents Who Just Made the Decision"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9195-355X","authenticated-orcid":false,"given":"Haoyang","family":"Yan","sequence":"first","affiliation":[{"name":"Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA"},{"name":"Department of Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4468-1093","authenticated-orcid":false,"given":"Cynthia","family":"Arslanian-Engoren","sequence":"additional","affiliation":[{"name":"Department of Health Behavior and Clinical Sciences, School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1194-8801","authenticated-orcid":false,"given":"Kenneth J.","family":"Pituch","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, C.S. Mott Children\u2019s Hospital, Michigan Medicine, Ann Arbor, MI 48109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3584-3513","authenticated-orcid":false,"given":"Patricia J.","family":"Deldin","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA"},{"name":"Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3811-7330","authenticated-orcid":false,"given":"Sandra A.","family":"Graham-Bermann","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3861-7327","authenticated-orcid":false,"given":"Stephanie K.","family":"Kukora","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, C.S. Mott Children\u2019s Hospital, Michigan Medicine, Ann Arbor, MI 48109, USA"},{"name":"Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.ijporl.2016.06.018","article-title":"Indications of pediatric tracheostomy over the last 30 years: Has anything changed?","volume":"87","author":"Gergin","year":"2016","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.jpeds.2018.07.045","article-title":"Caregiver perceptions about their decision to pursue tracheostomy for children with medical complexity","volume":"203","author":"Nageswaran","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1177\/1049909117739852","article-title":"Unexpected survivors: Children with life-limiting conditions of uncertain prognosis","volume":"35","author":"Nageswaran","year":"2018","journal-title":"Am. J. Hosp. Palliat. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1542\/peds.2013-4044","article-title":"Two infants, same prognosis, different parental preferences","volume":"135","author":"Antommaria","year":"2015","journal-title":"Pediatrics"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1097\/CCM.0000000000001396","article-title":"Shared decision making in ICUs: An American College of Critical Care Medicine and American Thoracic Society Policy Statement","volume":"44","author":"Kon","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1542\/peds.2008-2061","article-title":"Attitudes toward neonatal intensive care treatment of preterm infants with a high risk of developing long-term disabilities","volume":"123","author":"Lam","year":"2009","journal-title":"Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2464","DOI":"10.1097\/CCM.0b013e318255d85b","article-title":"Influence of personal preferences for life-sustaining treatment on medical decision making among pediatric intensivists","volume":"40","author":"Needle","year":"2012","journal-title":"Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2547","DOI":"10.1097\/01.CCM.0000239233.63425.1D","article-title":"End-of-life care for the critically ill: A national intensive care unit survey","volume":"34","author":"Nelson","year":"2006","journal-title":"Crit. Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1097\/PCC.0000000000002109","article-title":"Parental conflict, regret, and short-term impact on quality of life in tracheostomy decision-making","volume":"21","author":"October","year":"2020","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.apnr.2011.03.003","article-title":"Decisional conflict and regret: Consequences of surrogate decision making for the chronically critically ill","volume":"25","author":"Hickman","year":"2012","journal-title":"Appl. Nurs. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.siny.2017.09.003","article-title":"Values-based shared decision-making in the antenatal period","volume":"23","author":"Kukora","year":"2018","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1016\/j.ijporl.2013.07.020","article-title":"Parents\u2019 experiences and views of caring for a child with a tracheostomy: A literature review","volume":"77","author":"Flynn","year":"2013","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.pedn.2018.12.005","article-title":"A descriptive qualitative study of home care experiences in parents of children with tracheostomies","volume":"45","author":"Gong","year":"2019","journal-title":"J. Pediatr. Nurs."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3366","DOI":"10.1002\/ppul.25577","article-title":"Life with pediatric home ventilation: Expectations versus experience","volume":"56","author":"Henderson","year":"2021","journal-title":"Pediatr. Pulmonol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"109606","DOI":"10.1016\/j.ijporl.2019.109606","article-title":"Quality of life in paediatric tracheostomy patients and their caregivers\u2014A cross-sectional study","volume":"127","author":"Westwood","year":"2019","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1177\/10497323231217387","article-title":"\u201c100 things I wish someone would have told me\u201d: Everyday challenges parents face while caring for their children with a tracheostomy","volume":"34","author":"Sherman","year":"2024","journal-title":"Qual. Health Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.jpeds.2020.10.014","article-title":"Family experiences deciding for and against pediatric home ventilation","volume":"229","author":"Boss","year":"2021","journal-title":"J. Pediatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3094","DOI":"10.1002\/ppul.26140","article-title":"Collaborative decision-making: A framework for decision-making about life-sustaining treatments in children with medical complexity","volume":"57","author":"Nageswaran","year":"2022","journal-title":"Pediatr. Pulmonol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1093\/pch\/pxad042","article-title":"Parents\u2019 experiences of their children\u2019s medical journeys with tracheostomies: A focus group study","volume":"29","author":"Ofosu","year":"2024","journal-title":"Paediatr. Child Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1016\/j.acap.2020.06.004","article-title":"Decision making about tracheostomy for children with medical complexity: Caregiver and healthcare provider perspectives","volume":"20","author":"Gower","year":"2020","journal-title":"Acad. Pediatr."},{"key":"ref_21","first-page":"95","article-title":"The role of religion and spirituality in caregiver decision-making about tracheostomy for children with medical complexity","volume":"28","author":"Nageswaran","year":"2022","journal-title":"J. Health Care Chaplain."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1002\/ppul.25749","article-title":"Parent perspectives on facilitating decision-making around pediatric home ventilation","volume":"57","author":"Jabre","year":"2022","journal-title":"Pediatr. Pulmonol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1017\/S1478951522001122","article-title":"Tracheostomy decision-making for children with medical complexity: What supports and resources do caregivers need?","volume":"22","author":"Nageswaran","year":"2024","journal-title":"Palliat. Support Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1093\/jmp\/22.3.271","article-title":"The best-interests standard as threshold, ideal, and standard of reasonableness","volume":"22","author":"Kopelman","year":"1997","journal-title":"J. Med. Philos."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e2023061832","DOI":"10.1542\/peds.2023-061832","article-title":"Pediatric decision making: Consensus recommendations","volume":"152","author":"Salter","year":"2023","journal-title":"Pediatrics"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1097\/CCM.0000000000001965","article-title":"Defining futile and potentially inappropriate interventions: A policy statement from the Society of Critical Care Medicine Ethics Committee","volume":"44","author":"Kon","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Ericsson, K.A., Charness, N., Feltovich, P.J., and Hoffman, R.R. (2006). Decision-Making Expertise. The Cambridge Handbook of Expertise and Expert Performance, Cambridge University Press.","DOI":"10.1017\/CBO9780511816796"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1177\/0272989X13508008","article-title":"Participation of very old adults in health care decisions","volume":"34","author":"Bynum","year":"2014","journal-title":"Med. Decis. Mak."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/S1478951519000981","article-title":"Aiding end-of-life medical decision-making: A Cardinal Issue Perspective","volume":"18","author":"Yan","year":"2020","journal-title":"Palliat. Support. Care"},{"key":"ref_30","unstructured":"Morse, J.M., and Field, P.A. (1995). Qualitative Research Methods for Health Professionals, SAGE publications. [2nd ed.]."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"46","DOI":"10.63292\/FJCF5302","article-title":"Parents\u2019 perspectives on values and values conflicts impacting shared decision making for critically ill neonates","volume":"3","author":"Krenz","year":"2024","journal-title":"J. Pediatr. Ethics"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1177\/1049732312449210","article-title":"Divergent views of hope influencing communications between parents and hospital providers","volume":"22","author":"Roscigno","year":"2012","journal-title":"Qual. Health Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1177\/0272989X11421528","article-title":"What is known about parents\u2019 treatment decisions? A narrative review of pediatric decision making","volume":"32","author":"Lipstein","year":"2012","journal-title":"Med. Decis. Mak."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1001\/jamapediatrics.2014.2341","article-title":"Good-parent beliefs of parents of seriously ill children","volume":"169","author":"Feudtner","year":"2015","journal-title":"JAMA Pediatr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1111\/apa.16690","article-title":"A scoping review of parental values during prenatal decisions about treatment options after extremely premature birth","volume":"112","author":"Berken","year":"2023","journal-title":"Acta Paediatr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/00003246-200201000-00032","article-title":"Parental perspectives on end-of-life care in the pediatric intensive care unit","volume":"30","author":"Meyer","year":"2002","journal-title":"Crit. Care Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/PCC.0000000000000076","article-title":"The parent perspective: \u201cBeing a good parent\u201d when making critical decisions in the PICU","volume":"15","author":"October","year":"2014","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Valdez-Martinez, E., Noyes, J., and Bedolla, M. (2014). When to stop? Decision-making when children\u2019s cancer treatment is no longer curative: A mixed-method systematic review. BMC Pediatr., 14.","DOI":"10.1186\/1471-2431-14-124"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1542\/peds.2007-1972","article-title":"Values parents apply to decision-making regarding delivery room resuscitation for high-risk newborns","volume":"122","author":"Boss","year":"2008","journal-title":"Pediatrics"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1016\/j.pec.2019.06.011","article-title":"Not having adequate time to make a treatment decision can impact on cancer patients\u2019 care experience: Results of a cross-sectional study","volume":"102","author":"Herrmann","year":"2019","journal-title":"Patient Educ. Couns."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1002\/ppul.26884","article-title":"Tracheostomy and long-term invasive ventilation decision-making in children: A scoping review","volume":"59","author":"Mack","year":"2024","journal-title":"Pediatr. Pulmonol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2306","DOI":"10.1056\/NEJMp0906516","article-title":"The breadth of hopes","volume":"361","author":"Feudtner","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1111\/apa.13510","article-title":"What else are you hoping for? Fostering hope in paediatric serious illness","volume":"105","author":"Rosenberg","year":"2016","journal-title":"Acta Paediatr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1002\/ajmg.c.31526","article-title":"Parental hopes, interventions, and survival of neonates with trisomy 13 and trisomy 18","volume":"172","author":"Janvier","year":"2016","journal-title":"Am. J. Med. Genet. C Semin. Med. Genet."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1097\/00012272-199609000-00007","article-title":"Life support decisions for children: What do parents value?","volume":"19","author":"Kirschbaum","year":"1996","journal-title":"Adv. Nurs. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1177\/09697330211023986","article-title":"Conflicts between parents and clinicians: Tracheotomy decisions and clinical bioethics consultation","volume":"29","author":"Klee","year":"2022","journal-title":"Nurs. Ethics"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"S44","DOI":"10.1542\/peds.2013-3608H","article-title":"Tracheostomies and assisted ventilation in children with profound disabilities: Navigating family and professional values","volume":"133","author":"Wilfond","year":"2014","journal-title":"Pediatrics"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e592","DOI":"10.1097\/PCC.0000000000001341","article-title":"Discussing benefits and risks of tracheostomy: What physicians actually say","volume":"18","author":"Hebert","year":"2017","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1038\/jp.2017.118","article-title":"Communicating prognosis with parents of critically ill infants: Direct observation of clinician behaviors","volume":"37","author":"Boss","year":"2017","journal-title":"J. Perinatol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e20183819","DOI":"10.1542\/peds.2018-3819","article-title":"Neurologic outcome after prematurity: Perspectives of parents and clinicians","volume":"144","author":"Lemmon","year":"2019","journal-title":"Pediatrics"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Aung, W.T., Ong, N.Y., Yeo, S.Q.C., Juhari, N.S.B., Kong, G., Lim, N.A., Amin, Z., and Ng, Y.P.M. (2025). Impact of pediatric tracheostomy on family caregivers\u2019 burden and quality of life: A systematic review and meta-analysis. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1485544"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"5979","DOI":"10.1200\/JCO.2008.20.0204","article-title":"\u201cTrying to be a good parent\u201d as defined by interviews with parents who made phase I, terminal care, and resuscitation decisions for their children","volume":"27","author":"Hinds","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"114523","DOI":"10.1016\/j.socscimed.2021.114523","article-title":"Sample sizes for saturation in qualitative research: A systematic review of empirical tests","volume":"292","author":"Hennink","year":"2022","journal-title":"Soc. Sci. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How many interviews are enough?: An experiment with data saturation and variability","volume":"18","author":"Guest","year":"2006","journal-title":"Field Methods"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/9\/1115\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:35:29Z","timestamp":1760034929000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/9\/1115"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,25]]},"references-count":54,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["children12091115"],"URL":"https:\/\/doi.org\/10.3390\/children12091115","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2025,8,25]]}}}