Paediatricians’ Perspectives on Discharge Against Medical Advice in Children in Southwest Nigeria: A Qualitative Study

Abstract

Background: A paediatrician, as a child advocate, is trusted with actions that promote the health and well-being of children. He is caught between deciding what he thinks is best for the child and the caregiver's preferences, including a request to discharge against medical advice (DAMA).

Objective: To survey how paediatric resident doctors in a tertiary public health facility perceive, react to and manage DAMA requests by patients and their caregivers.

Methods: An in-depth interview of paediatric senior residents of the Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria. The data were transcribed and analysed using the thematic framework approach for qualitative data.

Results: The residents demonstrated a sound understanding of the definition of DAMA, which refers to a situation where a child is taken home before the attending physician has issued the discharge order. However, they differ in their perception of whether the caregivers understand the implications of their actions for DAMA. The caregiver, typically the father, signs the DAMA form. The major reason for DAMA is financial constraints. In contrast, the other reasons include caregiver burnout, unfriendly hospital environment, poor prognosis, poor communication and attitude of health workers, and religious and cultural beliefs. The caregiver, typically the father, signs the DAMA form.

Conclusions: Paediatric DAMA has the potential to increase morbidity and mortality rates. Caregivers should be adequately counselled, and the DAMA form must be signed to absolve the physician of complicity in the event of an adverse outcome post-discharge.