The Process of Parent's Decision-Making to Discharge their Child against Medical Advice (DAMA): A Qualitative Study

The parent's decision to discharge against medical advice (DAMA) can be challenging for the child, family, community, and healthcare system especially nurses.This study aimed to clarify the parental decision-making process for discharge their child against medical advice from the hospital.
This qualitative study was conducted using the Corbin and Strauss's grounded theory method, 2008. Data collecting and analyzing were carried out simultaneously between 2014 and 2016. By adopting purposive sampling from children's hospitals in Tehran, information was gathered using 29 in-depth, semi-structured interviews with parents, nurses and physician's assistants in their homes and workplaces. The MAXQDA software version 10 was used to manage and organize the data.
The theme of "towards distrust" was identified as the most important concern of the parents, with the following sub-categories: "lack of justification of illness and care", "expected care failure", "fear of deteriorating clinical conditions of the child," "clinical uncertainty," and "consultation and irresponsible guidance". "Psychological strategy of shirk responsibility for child care and treatment" was the most important process in parental decision-making for discharge their child against medical advice from the hospital and "towards distrust: the psychological strategy of shirk responsibility for child care and treatment" was identified as the core category.
Family-centered care can help parents to make the best and most appropriate decision to continue the child's care and treatment. Providing honest and accurate information can help parents to trust the health care centers and staffs. Designing a comprehensive discharge program in consult with parents would reduce the probability of premature childhood discharge against the recommendation of the treatment team.