End-of-life decisions in neonatal intensive care: physicians' self-reported practices in seven European countries

Cuttini, Marina; Nadai, Michela; Kaminski, Monique; Hansen, Gesine; Leeuw, R. de; Lenoir, Sophie; Persson, Jan; Rebagliato, Marisa; Reid, Margaret; Vonderweid, Umberto de; Lenard, H M; Orzalesi, M; Saracci, Rodolfo

doi:10.1016/s0140-6736(00)02378-3

Cited by 340 publications

(246 citation statements)

References 23 publications

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“…One of the significant differences between our research and most of the study conducted in the United States is that, usage of medication during the care in fewer variables in the United States than in most of the Middle East countries. Also, neonatologists in middleeast regions take all the efforts that make the neonate survive irrespective of the prognosis [17,18]. It is noteworthy that regardless of the benefits of the collaborative international studies, observations made in different countries cannot be generalized because of differences in the medical practices and local administrative guidelines.…”

Section: Discussionmentioning

confidence: 99%

Perception, Knowledge and Barriers to End of Life Palliative Care among Neonatal and Pediatric Intensive Care Physicians

Al-Hajery¹,

Almutairi²,

Ayed³

et al. 2018

J Palliat Care Med

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Objective: To determine perception, knowledge, and barriers to the end of life palliative care among neonatal and pediatric intensive care physicians mainly practicing in Kuwait.Methods: This study focuses a detailed self-administered questionnaire based measurements. One hundred and ninety-two (192) Kuwait based neonatal and pediatric intensive care physicians actively evaluated the survey conducted in this study. All the inquiries during this investigation were formatted using a 5-point Likert scale. However, responses to few questions are recorded in a yes or no format as 5-point Likert scale was not applicable to those issues. Results:The response rate was in a range of 80-85% with 157 respondents completing the survey. Of the total 157, 65% (102) were neonatologists and 35% (55) were pediatric intensivists. Thirty-two (21%) were consultant staff, and almost half (n=76, 48%) have more than ten years' experience. Only 20% had prior training in end of life palliative care, and 19% have a current guideline. Also, only 12% have access to palliative care consultation team. Four different factors from both family support and team were perceived to support the provision of palliative care of a high quality. While the involvement of multidisciplinary team, pain management and formal teaching of EOL palliative care were the major components of team factors; the family support also engaged the involvement of parents/family in EOL palliative care decision. Cultural and religious constraints, lack of palliative care team and insufficient knowledge formed as major barriers. Conclusion:In this study, neonatologists and pediatric intensivists reiterate the importance of palliative care. They evaluated both the facilitators (perception and knowledge) and barriers (cultural and religious constraints, lack of palliative care team and insufficient expertise) that significantly impact the quality of neonates and pediatrics palliative care.

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Section: Discussionmentioning

confidence: 99%

Perception, Knowledge and Barriers to End of Life Palliative Care among Neonatal and Pediatric Intensive Care Physicians

Al-Hajery¹,

Almutairi²,

Ayed³

et al. 2018

J Palliat Care Med

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“…Several studies have indicated that 'sanctity of life' and 'treat until certainty' rather than 'quality of life' is the prevailing principle in the United States and eastern European countries whereas decisions considering 'quality of life' are more prevalent in western Europe. [1][2][3][4] A conservative attitude advocating 'sanctity of life' is commonly held by communities with a strong religious affiliation, more so among Catholics than Protestants, and less by seculars. Cultural background, personal experience and education are also relevant.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6][7][8] Many studies on end-of-life decisions in the neonatal intensive care unit (NICU) have focused on the attitude of the medical staff, mainly physicians. [3][4][5]9 An association was found between their cultural and religious background and ethical views and their actual practicing end-of-life decisions. [3][4][5] Nevertheless, in several studies, country remained the most determinant factor of the practice to withhold or withdraw treatment.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5]9 An association was found between their cultural and religious background and ethical views and their actual practicing end-of-life decisions. [3][4][5] Nevertheless, in several studies, country remained the most determinant factor of the practice to withhold or withdraw treatment. 3,4 The impact of countries' strategies for treatment on the outcome of very premature infants has been recently studied comparing New Jersey and the Netherlands.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] Nevertheless, in several studies, country remained the most determinant factor of the practice to withhold or withdraw treatment. 3,4 The impact of countries' strategies for treatment on the outcome of very premature infants has been recently studied comparing New Jersey and the Netherlands. 2 A conservative attitude in applying life-sustaining measures in the United States resulted in doubling the percentage of survivors, but also in higher prevalence of disabling cerebral palsy.…”

Section: Introductionmentioning

confidence: 99%

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Parental religious affiliation and survival of premature infants with severe intraventricular hemorrhage

2008

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Objective: To evaluate the association between parents' ethnic/religious affiliation (secular Jewish, religious Jewish, ultra-orthodox Jewish, Muslim Arabs) and survival of premature infants with severe intraventricular hemorrhage (IVH).Study Design: Survival of 102 infants (birth weightp1500 g) born at the Hadassah hospitals in Jerusalem from 1 January 1996 through 31 December 2005, who sustained severe IVH and who survived over 48 h, was assessed in relation to their parents' ethnic/religious affiliation and accounting for relevant clinical and demographic variables.Result: There were 38 cases of demise among 72 infants with IVH grade IV (52.8%), and 4 among 30 infants with IVH grade III (13.3%). In a multivariate logistic regression analysis accounting for relevant perinatal variables, the odds for mortality compared to the reference Arab group was significantly lower only with regard to ultra-orthodox patients (odds ratio, OR ¼ 0.06; 95% confidential interval, CI ¼ 0.00 to 0.80; P ¼ 0.033). In a logistic and in the Cox stepwise regression analyses with religion as forced in variable, comparing infants with IVH grade IV of religious and ultraorthodox Jewish families with those of secular Jewish families, the OR/ hazard ratio (HR) for mortality were OR ¼ 0.10; 95% CI ¼ 0.01 to 0.06; P ¼ 0.017, and HR ¼ 0.37; 95% CI ¼ 0.16 to 0.85; P ¼ 0.019, respectively. No significant difference between the groups was demonstrated when infants with IVH grade III were analyzed apart.Conclusion: Parental religious affiliation may be influential on the outcome of premature infants with severe brain damage.

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Forgoing Treatment at the End of Life in 6 European Countries

et al. 2005

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End-of-life decisions in neonatal intensive care: physicians' self-reported practices in seven European countries

Cited by 340 publications

References 23 publications

Perception, Knowledge and Barriers to End of Life Palliative Care among Neonatal and Pediatric Intensive Care Physicians

Perception, Knowledge and Barriers to End of Life Palliative Care among Neonatal and Pediatric Intensive Care Physicians

Parental religious affiliation and survival of premature infants with severe intraventricular hemorrhage

Forgoing Treatment at the End of Life in 6 European Countries

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