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Correspondence to Professor Liz Forbat, Faculty of Social Sciences, University of Stirling, Stirling FK9 4lA, UK; [email protected]
What is already known on this topic?
Conflict is a frequent component of paediatric services and can have severe consequences for staff, patients, families and services.
Few strategies exist to enable clinicians to manage conflict.
If conflict is not managed effectively, cases escalate and can result in high-profile court action.
What this study adds?
Incidence and severity of conflict can be reduced in paediatric oncology by using the conflict management framework.
Staff find the conflict management framework helpful.
Using the conflict management framework reduces staff burn-out.
Background
Serious conflicts in paediatric services have resulted in ‘intense national and international scrutiny’ (p1891).1 Conflicts between patients, families and staff in paediatric health services are damaging to everyone involved: the child, the family members and the treating clinicians. Advances in life-sustaining interventions mean that more babies and children live longer and access oncology services for many years, but often live with greater morbidity. Clinical implications include an increased frequency in difficult decision-making regarding the benefits versus the burden of intensive and invasive treatment, especially when curative treatment is no longer possible. Such circumstances have been brought into sharp focus by cases such as Ashya King,2 where the parents and healthcare professionals disagreed about the benefits and burden of proton beam therapy to treat his cancer. Such disagreements can and do lead to communication breakdown between clinicians, patients and relatives, as well as between the clinicians themselves. The multipartner nature of much paediatric work, such as the triad dynamic of clinicians, patient and relatives, may increase the potential for disagreement and conflict.3
Paediatric conflicts tend to escalate through three distinct phases (mild, moderate and severe) if not recognised and managed early, and such conflicts can have long-lasting impact.4 Time taken up with managing conflict can be considerable,5 with communication breakdown, disagreements over treatment and unrealistic expectations cited as common causes.
If conflict is not identified and resolved at an early stage, differences in viewpoint can become entrenched and lead to court action or public confrontation, exemplified by recent cases internationally.2 6–10 The use of court interventions is both financially and emotionally damaging to all parties....