Discussing withdrawing and withholding of life‐sustaining medical treatment in a tertiary paediatric hospital: A survey of clinician attitudes and practices

Forbes, Thomas A.; Goeman, Emma; Stark, Zornitza; Hynson, Jenny; Forrester, Mike

doi:10.1111/j.1440-1754.2008.01351.x

Cited by 30 publications

(65 citation statements)

References 52 publications

(69 reference statements)

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“…Notably, we found that clinicians perceive parental factors as the most common barriers. This finding is consistent with earlier studies, 17,23,24 which found parental prognostic uncertainty, unrealistic expectations, and lack of readiness to participate in ACP as barriers to optimal care. However, our study expands on earlier findings in that it includes perspectives of both nurses and physicians who are from multiple care settings.…”

Section: Discussionsupporting

confidence: 94%

Barriers to Conducting Advance Care Discussions for Children With Life-Threatening Conditions

Zurakowski²,

2012

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Section: Discussionsupporting

confidence: 94%

Barriers to Conducting Advance Care Discussions for Children With Life-Threatening Conditions

Zurakowski²,

2012

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“…5,45,48 In order to facilitate such discussions, pediatricians’ communication skills need to be improved by communication trainings and guides. 17 Adult approaches to communication in conflictual meetings with relatives could be adapted. 49 Moreover, advance care planning may provide a means for mitigating conflicts because it focuses on a guided process of information transfer, exploration of wishes and values, and negotiation of goals, aiming at shared decision-making and good quality of communication.…”

Section: Discussionmentioning

confidence: 99%

Medical indication regarding life-sustaining treatment for children: Focus groups with clinicians

Lotz

Jox²,

Meurer³

et al. 2016

Palliat Med

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Background:Decisions about medical indication are a relevant problem in pediatrics. Difficulties arise from the high prognostic uncertainty, the decisional incapacity of many children, the importance of the family, and conflicts with parents. The objectivity of judgments about medical indication has been questioned. Yet, little is known about the factors pediatricians actually include in their decisions.Aim:Our aims were to investigate which factors pediatricians apply in deciding about medical indication, and how they manage conflicts with parents.Design:We performed a qualitative focus group study with experienced pediatricians. The transcripts were subjected to qualitative content analysis.Setting/participants:We conducted three focus groups with pediatricians from different specialties caring for severely ill children/adolescents. They discussed life-sustaining treatment in two case scenarios that varied according to diagnosis, age, and gender.Results:The decisions about medical indication were based on considerations relating to the individual patient, to the family, and to other patients. Individual patient factors included clinical aspects and benefit–burden considerations. Physicians’ individual views and feelings influenced their decision-making. Different factors were applied or weighed differently in the two cases. In case of conflict with parents, physicians preferred solutions aimed at establishing consensus.Conclusion:The pediatricians defined medical indication on a case-by-case basis and were influenced by emotional reasoning. In contrast to prevailing ethico-legal principles, they included the interests of other persons in their decisions. Decision-making strategies should incorporate explicit discussions of social aspects and physicians’ feelings to improve the transparency of the decision-making process and reduce bias.

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“…Yet, by communicating belatedly or in a manner that is too tempered, physicians risk under-informing families. Box 2 lists potential challenges to ACP that we and other medical caregivers of children with complex chronic conditions have encountered (17, 21, 24-27). Challenges can stem from both families and health care providers.…”

Section: Discussionmentioning

confidence: 99%

End-Of-Life Discussions and Advance Care Planning for Children on Long-Term Assisted Ventilation with Life-Limiting Conditions

et al. 2012

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Families of children with life-limiting conditions who are on long-term assisted ventilation need to undertake end-of-life advance care planning (ACP) in order to align their goals and values with the inevitability of their child's condition and the risks it entails. To discuss how best to conduct ACP in this population, we performed a retrospective analysis of end-of-life discussions involving our deceased ventilator-assisted patients between 1987 and 2009. A total of 34 (72 percent) of 47 study patients were the subject of these discussions; many discussions occurred after acute deterioration. They resulted in directives to forgo or limit interventions for 21 children (45 percent). We surmise that many families were hesitant to discuss end-of-life issues during periods of relative stability. By offering anticipatory guidance and encouraging contemplation of patients’ goals both in times of stability and during worsening illness, health care providers can better engage patients’ families in ACP. As the child's condition progresses, the emphasis can be recalibrated. How families respond to such encouragement can also serve as a gauge of their willingness to pursue ACP.

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Discussing withdrawing and withholding of life‐sustaining medical treatment in a tertiary paediatric hospital: A survey of clinician attitudes and practices

Cited by 30 publications

References 52 publications

Barriers to Conducting Advance Care Discussions for Children With Life-Threatening Conditions

Barriers to Conducting Advance Care Discussions for Children With Life-Threatening Conditions

Medical indication regarding life-sustaining treatment for children: Focus groups with clinicians

End-Of-Life Discussions and Advance Care Planning for Children on Long-Term Assisted Ventilation with Life-Limiting Conditions

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