Physician perspectives on end-of-life care and pediatric palliative care for children in the Republic of Korea


Physician perspectives on end-of-life care and pediatric palliative care for children in the Republic of Korea


Kim M S; Kim C H; Yu J; Song IG


Cogent Medicine




advance care planning; palliative therapy; South Korea; adult; child; conference abstract; death; deterioration; diagnosis; female; financial management; human; interview; life sustaining treatment; male; organization; perception; psychosocial care; questionnaire; tertiary care center


Introduction: Despite significant advances in disease treatment, resources for the pediatric palliative care (PPC) for children with serious illnesses are limited in South Korea. The obstacles to provide optimal PPC include inadequate funding, shortage of specialized professionals, and healthcare system, but the perception of health professionals is also very important. Purpose: This study explored pediatric doctors' perception of end-of-life care and needs on PPC in Korea. Materials and Methods: The study survey was developed based on a review of the palliative care literature and sample physician interview. A questionnaire was sent via online survey and mail to the pediatric doctors with specialized boards working at 43 tertiary hospitals in South Korea. Results: A total of 118 doctors responded to the survey. The median age was 37 years, 53% were female and 76% answered they have own child. Eighty percent responded that, in the previous 2 years, they cared for more than one pediatric patient who died. When asked about appropriate age for terminal state disclosure, 6%, 30%, 42% and 14% answered that pediatric patients should be informed if they are aged over 4, 7, 12, and 15 years old respectively. As for the life-sustaining treatments (LSTs) decision, 24% answered that discussions should be started when a child is diagnosed with incurable diseases, and 48% said advance care planning is needed in a state of constant deterioration even though actual death is not expected. Although only 7% of pediatric doctors had personal desire for use of LSTs when their own disease is incurable and in the deteriorating state, more respondents (29%) showed preferences to LSTs for children in the same situation. More than half of the respondents answered that they are not confident about advance care planning including LST decisions. Most respondents reported experiencing difficulties in PPC areas such as symptom management, ethical problems, and psychosocial support more than once every six months. Pediatric doctors indicated to the barriers to pediatric palliative care implementation as follows: the attitude of parents who prefer aggressive treatment (19%), shortage of PPC professionals and organizations (18%), negative perception on PPC among health professionals (16%), lack of financial support for PPC (12%), inadequate linkage between curative and palliative care (12%), and difficulties to decide when to refer a patient to PPC (10%). Conclusion: Our study showed pediatric doctors in Korea have low preferences to LSTs for children in the terminal state and perceive the needs of PPC. The results will guide the health authorities to design PPC program in Korea.


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Kim M S; Kim C H; Yu J; Song IG, “Physician perspectives on end-of-life care and pediatric palliative care for children in the Republic of Korea,” Pediatric Palliative Care Library, accessed May 20, 2024,