Physicians’ attitudes and experiences about withholding/withdrawing life-sustaining treatments in pediatrics: a systematic review of quantitative evidence

Abstract

Background One of the most important and ethically challenging decisions made for children with life-limiting conditions is withholding/withdrawing life-sustaining treatments (LST). As important (co-)decision-makers in this process, physicians are expected to have deeply and broadly developed views. However, their attitudes and experiences in this area remain difficult to understand because of the diversity of the studies. Hence, the aim of this paper is to describe physicians’ attitudes and experiences about withholding/withdrawing LST in pediatrics and to identify the influencing factors. Methods We systematically searched Pubmed, Cinahl®, Embase®, Scopus®, and Web of Science™ in early 2021 and updated the search results in late 2021. Eligible articles were published in English, reported on investigations of physicians’ attitudes and experiences about withholding/withdrawing LST for children, and were quantitative. Results In 23 included articles, overall, physicians stated that withholding/withdrawing LST can be ethically legitimate for children with life-limiting conditions. Physicians tended to follow parents’ and parents-patient’s wishes about withholding/withdrawing or continuing LST when they specified treatment preferences. Although most physicians agreed to share decision-making with parents and/or children, they nonetheless reported experiencing both negative and positive feelings during the decision-making process. Moderating factors were identified, including barriers to and facilitators of withholding/withdrawing LST. In general, there was only a limited number of quantitative studies to support the hypothesis that some factors can influence physicians’ attitudes and experiences toward LST. Conclusion Overall, physicians agreed to withhold/withdraw LST in dying patients, followed parent-patients’ wishes, and involved them in decision-making. Barriers and facilitators relevant to the decision-making regarding withholding/withdrawing LST were identified. Future studies should explore children’s involvement in decision-making and consider barriers that hinder implementation of decisions about withholding/withdrawing LST.

Chinese and Belgian pediatricians’ perspectives toward pediatric palliative care: an online survey

“…Pediatricians play an important role in PPC as co-decision-makers and are crucial in initiating PPC [ 15 ]. Still, some physicians perceive the PPC decision-making ethically challenging [ 16 , 17 ].…”

Bioethical, medical, and social problems in children with growth hormone deficiency

“…ально-економічні проблеми надання медичної допомоги дитячому населенню [3,4], розглядає моральні аспекти взаємин хворої дитини, батьків та лікарів-педіатрів у різних медико-соціальних обставинах [5,6]. З нашої точки зору, ще недостатньо досліджені біоетичні проблеми низькорослих дітей, зокрема з дефіцитом гормону росту (ДГР).…”

“…В Україні цю роботу покладено на локальні етичні комі-УДК 616.432-008. 6 Ідентифікація біоетичних та медико-соціальних проблем проводилась за результатами анкетування, збору анамнезу, бесід, об'єктивного обстеження пацієнтів та аналізу медичної документації у когорті, до якої уві-йшли 94 дитини з ДГР віком 7,2 ± 0,4 року з низьким зростом (SDS 3,4 ± 0,1) та їх батьків (124). Анкетування було анонімним та проводилося під час амбулаторних прийомів дітей з ДГР.…”