Knafl, 2005). The diverse methods required the use of an integrated review methodology. Therefore with a large number of variables expected and multiple types of study designs anticipated to explore the complexInt J Nurs Stud. Author manuscript; available in PMC 2015 September 01.AllenPageprocess of decision-making, an integrated literature review method of chosen. This method allows for synthesis of many designs and variables to draw conclusions from the empirical literature available. See Table 1 for more details on the integrated literature review method utilized in this review. PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and PsycINFO were searched using the combined key terms `parents and decision-making’ to obtain English language publications from 2000 to June 2013. The GS-5816 web search strategy generated 336 articles relevant based on their FCCP web titles with 305 articles eliminated after review of the abstract. A total of 31 articles retained for this integrated review. The inclusion criteria were English language studies of factors impacting parental decision-making for infants and children with life-threatening illnesses. The decisions had to involve life-sustaining treatments with the intent to cure a significant life-threatening illness (e.g., congenital heart disease, extreme prematurity) or withdrawal and termination of treatments with probable death as the outcome. Infants and children were defined as those <12 years of age. The exclusion criteria were studies of decisions about non-life-threatening illnesses, children with cancer, and decisions about organ donation. The time frame of 13 years was chosen because the success in treatment for medically complex infants and children has improved substantially in the past decade (Bell, 2007). In addition, the level of involvement of parents in the decision-making process has changed due to the influence of shared decision-making and the endorsement of involving individuals in their health care (Kon, 2010; Malusky, 2005; van den Brink-Muinen et al., 2006).NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript 3. ResultsThe findings from each of the 31 articles retained were recorded into a matrix extracting themes and definitions of each theme as described by the authors (see Table 2). Disease characteristics of the ill children ranged from extremely premature infants to those with neurological injuries or genetic abnormalities to term infants with metabolic disease. The sample generally included parents or providers. The main study designs were crosssectional, qualitative descriptive. The definitions from each article were then synthesized to develop themes. Within each theme if the definitions varied across different decisions it was described. The themes included information needs, seriousness of illness, no other treatment options, child's best interests, religiosity and spirituality, parental characteristics and past experiences, and emotional support. 3.1. Information needs Parents relied on information to make decisions throughout their child's life. When the child was initially diagnosed with a life-threatening illness and information about the illness was necessary (Grobman et al., 2010; Moro et al., 2011). However, being in a state of emotional shock after receiving the diagnosis of a life-threatening illness (Boss et al., 2008; Lan et al., 2007; Payot et al., 2007; Vandvik and Forde, 2000) and during other critical changes within th.Knafl, 2005). The diverse methods required the use of an integrated review methodology. Therefore with a large number of variables expected and multiple types of study designs anticipated to explore the complexInt J Nurs Stud. Author manuscript; available in PMC 2015 September 01.AllenPageprocess of decision-making, an integrated literature review method of chosen. This method allows for synthesis of many designs and variables to draw conclusions from the empirical literature available. See Table 1 for more details on the integrated literature review method utilized in this review. PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and PsycINFO were searched using the combined key terms `parents and decision-making' to obtain English language publications from 2000 to June 2013. The search strategy generated 336 articles relevant based on their titles with 305 articles eliminated after review of the abstract. A total of 31 articles retained for this integrated review. The inclusion criteria were English language studies of factors impacting parental decision-making for infants and children with life-threatening illnesses. The decisions had to involve life-sustaining treatments with the intent to cure a significant life-threatening illness (e.g., congenital heart disease, extreme prematurity) or withdrawal and termination of treatments with probable death as the outcome. Infants and children were defined as those <12 years of age. The exclusion criteria were studies of decisions about non-life-threatening illnesses, children with cancer, and decisions about organ donation. The time frame of 13 years was chosen because the success in treatment for medically complex infants and children has improved substantially in the past decade (Bell, 2007). In addition, the level of involvement of parents in the decision-making process has changed due to the influence of shared decision-making and the endorsement of involving individuals in their health care (Kon, 2010; Malusky, 2005; van den Brink-Muinen et al., 2006).NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript 3. ResultsThe findings from each of the 31 articles retained were recorded into a matrix extracting themes and definitions of each theme as described by the authors (see Table 2). Disease characteristics of the ill children ranged from extremely premature infants to those with neurological injuries or genetic abnormalities to term infants with metabolic disease. The sample generally included parents or providers. The main study designs were crosssectional, qualitative descriptive. The definitions from each article were then synthesized to develop themes. Within each theme if the definitions varied across different decisions it was described. The themes included information needs, seriousness of illness, no other treatment options, child's best interests, religiosity and spirituality, parental characteristics and past experiences, and emotional support. 3.1. Information needs Parents relied on information to make decisions throughout their child's life. When the child was initially diagnosed with a life-threatening illness and information about the illness was necessary (Grobman et al., 2010; Moro et al., 2011). However, being in a state of emotional shock after receiving the diagnosis of a life-threatening illness (Boss et al., 2008; Lan et al., 2007; Payot et al., 2007; Vandvik and Forde, 2000) and during other critical changes within th.
