Management dilemmas in pediatric nephrology: moving from friction to flourishing in "challenging" cases

Authors

Celina Brunson, Department of Pediatrics, George Washington University, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, USA.
Taylor R. House, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin Madison, 600 Highland Ave, Madison, WI, 53792, USA. trhouse@wisc.edu.
Damien Noone, Department of Pediatrics, Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
Aaron Wightman, Department of Pediatrics, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA.

Document Type

Journal Article

Publication Date

4-26-2024

Journal

Pediatric nephrology (Berlin, Germany)

DOI

10.1007/s00467-024-06384-8

Keywords

Cultural humility; Medical mistrust; Moral distress; Palliative care; Social determinants of health; Structural racism

Abstract

BACKGROUND: The circumstances surrounding chronic kidney disease and its impact on families can be complex and difficult to navigate, leading to these cases being labeled "challenging." CASE PRESENTATION: We present the case of an adolescent with kidney failure due to unremitting systemic illness and multiple complications ultimately resulting in the family's request to forgo dialysis. Medical team members wrestled with meeting the family's needs among internal and external constraints. CONCLUSION: Past experiences, systemic inequities, differing perspectives, and consequential decision-making within individual belief systems can lead to friction between and among medical team members and families. As pediatric nephrologists, we must shift our focus from the "challenging" patient or family to addressing what is challenging their ability to flourishing.

APA Citation

Brunson, Celina; House, Taylor R.; Noone, Damien; and Wightman, Aaron, "Management dilemmas in pediatric nephrology: moving from friction to flourishing in "challenging" cases" (2024). GW Authored Works. Paper 4670.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4670

Department

Pediatrics