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


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


Bell C; Dittborn M; Brierley J






Dispute; end-of-life; Impact on Trainees; Paediatric intensive care (PIC); Trainees


Introduction This 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.Methods Semi-structured interviews were conducted with nine PIC-GRID trainees (Apr-Aug 2021). Interview transcripts were analysed using thematic analysis.Results Six 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.Conclusion UK 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.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis study did not receive any fundingAuthor DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Study approval by GOSH-Clinical Research Adoptions Committee (ID 20HL11), UCL-ethics committee (ID 18271/001), and the Health Research Authority Research Ethics Committee (ID 278437).I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesDeidentified participant in erview transcripts, are available from Dr Clare Bell, ORCID identifier 0000-0002-8331-5758 reuse is permitted after discussion with the research team in related research.


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Bell C; Dittborn M; Brierley J, “What is the impact of high-profile end-of-life disputes on Paediatric Intensive Care (PIC) trainees? Original research,” Pediatric Palliative Care Library, accessed May 24, 2024, https://pedpalascnetlibrary.omeka.net/items/show/18622.