Article Text

  1. A. Epstein,
  2. T. Morrison1,
  3. P. Agbayani1,
  4. A. Herrera1,
  5. D. Epstein2
  1. California State University, Los Angeles, Los Angeles, CA
  2. 1Mattel Children's Hospital, Los Angeles, CA
  3. 2Children's Hospital Los Angeles, Los Angeles, CA


Purpose It has often been assumed that Latino parents prefer a paternalistic approach to medical decision making, as opposed to the autonomous or shared decision-making model widely used in the United States today. We sought to identify the preferred decision-making model of the Latino parent with a child admitted to the pediatric intensive care unit (PICU) and assess the impact of acculturation on this model.

Methods A 24-question, prospective survey of Latino parents with children admitted to the PICU at Mattel Children's Hospital at UCLA in April 2006 was performed. Data collected: mother, father, and child ages; who completed the survey; parent marital status; length of admission in the PICU; severity of child's illness; number of prior hospital and PICU admissions; birthplace of parent completing the survey; length of residence in the United States; language spoken at home; in which language did the subject think; language parent used to complete the survey; parent education level; medical insurance; annual family income; and five Likert scale questions (evaluating autonomous, paternalistic, or shared decision-making practices). The Fisher's exact test and Kruskal-Wallis nonparametric ANOVA test were used for statistical analysis.

Results Twenty surveys were completed. There was no statistically significant difference in the answering of the decision-making questions with regard to the variables assessing the degree of acculturation. For questions assessing decision-making models, two focused on paternalism, two focused on autonomy, and one focused on shared decision making. Upon converting the Likert scale to a number ranking (strongly agree = 4, agree = 3, disagree = 2, and strongly disagree = 1; undecided answers excluded), the mean ± SD response for paternalistic questions = 2.0 ± 0.8, autonomous questions = 2.7 ± 1.2, and shared decision-making question = 3.7 ± 0.6. Using the Kruskal-Wallis nonparametric ANOVA test, the variation among the means was significantly greater than expected by chance (p < .0001).

Conclusion The degree of acculturation did not affect the medical decision-making model of Latino parents. Furthermore, the majority of Latino parents preferred a shared decision-making model to make medical decisions about their child's medical care in the PICU. These findings indicate the importance for medical professionals to thoroughly assess and be sensitive to each family's views of making a medical decision.

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