Tensions At The End Of Life In Pediatrics: Actors, Causes, Coping Strategies And Remedies
Title
Tensions At The End Of Life In Pediatrics: Actors, Causes, Coping Strategies And Remedies
Creator
Antoine Payot; Marie-Anne Archambault-Grenier; Marie-Hélène Roy-Gagnon; Nago H; Sanja Stojanovic; Janvier A; Michel Duval
Identifier
DOI: http://dx.doi.org/10.1016/j.jpainsymman.2016.10.023
Publisher
Journal Of Pain And Symptom Management
Date
2016
Description
Background: The majority of children die in pediatric
hospitals after a decision to withhold or withdraw
life sustaining interventions. Tensions and conflicts
at the end of life (EOL) are not rare in pediatric
hospitals.
Objective: To investigate how frequent these conflicts
are and how health-care professionals (HCPs) experience,
cope and suggest improvements regarding endof-life
communications in pediatrics.
Design/Methods: Questionnaire sent to all 2300 HCPs
who care for patients in a large mother-child university
hospital.
Results: 946 HCPs answered the questionnaire (nurses,
physicians and other disciplines). A majority (70%,
663) had witnessed or cared for at least one dying child
over the preceding five years. Of those, 73% experienced
at least a conflict at the end of life. Conflict
occurred more frequently among HCPs (58%) than between
HCPs and parents (33%), p LT 0.05.
More than 40% reported the following factors as being
frequently associated with end-of-life conflicts:
- HCP Related: lack of continuity (physicians and/
or nurses), differences in values and beliefs between
HCP.
- Patient-Disease Related: precipitated or critical situations,
uncertain prognosis.
- Parent Related: unprepared parents, emotional load,
unrealistic parental expectations, differences in
values and beliefs, parents’ fear of hastening death.
- Institution Related: lack of practical guidelines to
deal with difficult end-of-life cases.
HCP report using these strategies to solve confrontations:
negotiating with parents and patients, educating
parents and discussing with peers. Nurses and physicians
reported significantly different types of coping strategies.
For 66% of respondents, conflicts were resolved
by the time of the child’s death. Only 25% felt they
received adequate training to cope with EOL conflicts.
Suggestions for improvement: primary health-care providers
or case-managers, interdisciplinary meetings
involving the parents, post-death ethics meetings,
bereavement follow-up protocols and earlier consultation
in pediatric palliative care and/or clinical ethics service.
Conclusions: End-of-life conflicts are frequent in pediatrics.
The main source of tension is between providers
who may have different views and values. Coping mechanisms
may be different from one provider to another,
but many identify useful strategies to solve conflicts.
Future research should investigate whether these perspectives
parallel those of parents and patients.
hospitals after a decision to withhold or withdraw
life sustaining interventions. Tensions and conflicts
at the end of life (EOL) are not rare in pediatric
hospitals.
Objective: To investigate how frequent these conflicts
are and how health-care professionals (HCPs) experience,
cope and suggest improvements regarding endof-life
communications in pediatrics.
Design/Methods: Questionnaire sent to all 2300 HCPs
who care for patients in a large mother-child university
hospital.
Results: 946 HCPs answered the questionnaire (nurses,
physicians and other disciplines). A majority (70%,
663) had witnessed or cared for at least one dying child
over the preceding five years. Of those, 73% experienced
at least a conflict at the end of life. Conflict
occurred more frequently among HCPs (58%) than between
HCPs and parents (33%), p LT 0.05.
More than 40% reported the following factors as being
frequently associated with end-of-life conflicts:
- HCP Related: lack of continuity (physicians and/
or nurses), differences in values and beliefs between
HCP.
- Patient-Disease Related: precipitated or critical situations,
uncertain prognosis.
- Parent Related: unprepared parents, emotional load,
unrealistic parental expectations, differences in
values and beliefs, parents’ fear of hastening death.
- Institution Related: lack of practical guidelines to
deal with difficult end-of-life cases.
HCP report using these strategies to solve confrontations:
negotiating with parents and patients, educating
parents and discussing with peers. Nurses and physicians
reported significantly different types of coping strategies.
For 66% of respondents, conflicts were resolved
by the time of the child’s death. Only 25% felt they
received adequate training to cope with EOL conflicts.
Suggestions for improvement: primary health-care providers
or case-managers, interdisciplinary meetings
involving the parents, post-death ethics meetings,
bereavement follow-up protocols and earlier consultation
in pediatric palliative care and/or clinical ethics service.
Conclusions: End-of-life conflicts are frequent in pediatrics.
The main source of tension is between providers
who may have different views and values. Coping mechanisms
may be different from one provider to another,
but many identify useful strategies to solve conflicts.
Future research should investigate whether these perspectives
parallel those of parents and patients.
Rights
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Citation List Month
December 2016 List
Citation
Antoine Payot; Marie-Anne Archambault-Grenier; Marie-Hélène Roy-Gagnon; Nago H; Sanja Stojanovic; Janvier A; Michel Duval, “Tensions At The End Of Life In Pediatrics: Actors, Causes, Coping Strategies And Remedies,” Pediatric Palliative Care Library, accessed April 23, 2024, https://pedpalascnetlibrary.omeka.net/items/show/10509.