What is the impact of high-profile end-of-life disputes on Paediatric Intensive Care (PIC) trainees? Original research

Abstract

IntroductionThis study explores UK Paediatric Intensive Care (PIC) trainees’ thoughts and feelings about high-profile end-of-life cases recently featured in the press and social media and the impact on their career intentions.MethodsSemi-structured interviews were conducted with nine PIC-GRID trainees (Apr-Aug 2021). Interview transcripts were analysed using thematic analysis.ResultsSix main themes were identified: (i) All participants wished to do what was best for the child, feeling conflicted if this meant disagreeing with parents. (ii) Interviewees felt unprepared and expressed deep concern about the effect of high-profile cases on their future career. (iii) They highlighted too often being shielded from involvement in challenging discussions. (iv) Working in a supportive environment is crucial, underscoring the importance of clear and unified team communication, but specific training on the ethical and legal nuances of such cases is required. (vi) All had purposefully minimised their social media presence. (vi) All had reconsidered training in PIC due to concerns about future high-profile end-of-life disputes; despite describing this as a cause of concern and anxiety, all were still in training.ConclusionUK PIC trainees feel unprepared and anxious about future high-profile cases. A parallel can be drawn to child protection improvements following significant educational investment after Government reports into preventable child abuse deaths. Models for supporting trainees and establishing formal PIC training are required to improve trainees’ confidence and skills in managing high-profile cases. Further research with other professional groups, the families involved, and other stakeholders would provide a more rounded picture.What is already known on this topic– PIC trainees report high levels of distress associated to children’s death and disagreements with the families.What this study adds– PIC doctors are extremely concerned about future high-profile end-of-life disputes, the effect on themselves and their career. They feel unprepared to manage them and require more training, experience and recognition of this.How this study might affect research, practice or policy– PIC trainee curriculum and training scheme should prepare doctors to deal with high-profile end-of-life cases to ensure children and families receive appropriate care and avoid PIC-induced moral injury and workforce burdens.