End-of-life Decisions and Practices as Viewed by Health Professionals in Pediatric Critical Care: A European Survey Study

Title

End-of-life Decisions and Practices as Viewed by Health Professionals in Pediatric Critical Care: A European Survey Study

Creator

Zanin A; Brierley J; Latour JM; Gawronski O

Publisher

Frontiers in Pediatrics

Date

2022

Subject

Decision Making; end-of-life (EOL); end-of-life (EOL); ethics; pediatric critical care

Description

BACKGROUND AND AIM: End-of-Life (EOL) decision-making in paediatric critical care can be complex and heterogeneous, reflecting national culture and law as well as the relative resources provided for healthcare. This study aimed to identify similarities and differences in the experiences and attitudes of European paediatric intensive care doctors, nurses and allied health professionals about end-of-life decision-making and care. METHODS: This was a cross-sectional observational study in which we distributed an electronic survey to the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) members by email and social media. The survey had three sections: (i) 16 items about attitudes to EOL care, (ii) 14 items about EOL decisions, and (iii) 18 items about EOL care in practice. We used a 5-point Likert scale and performed descriptive statistical analysis. RESULTS: Overall, 198 questionnaires were completed by physicians (62%), nurses (34%) and allied health professionals (4%). Nurses reported less active involvement in decision-making processes than doctors (64% vs. 95%; p < 0.001). As viewed by the child and family, the child's expected future quality of life was recognised as one of the most critical considerations in EOL decision-making. Sub-analysis of Northern, Central and Southern European regions revealed differences in the optimal timing of EOL decisions. Most respondents (n = 179; 90%) supported discussing organ donation with parents during EOL planning. In the sub-region analysis, differences were observed in the provision of deep sedation and nutritional support during EOL care. CONCLUSIONS: This study has shown similar attitudes and experiences of EOL care among paediatric critical care professionals within European regions, but differences persist between European regions. Nurses are less involved in EOL decision-making than physicians. Further research should identify the key cultural, religious, legal and resource differences underlying these discrepancies. We recommend multi-professional ethics education to improve EOL care in European Paediatric Intensive Care.

Rights

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Citation List Month

March List 2023

Collection

Citation

Zanin A; Brierley J; Latour JM; Gawronski O, “End-of-life Decisions and Practices as Viewed by Health Professionals in Pediatric Critical Care: A European Survey Study,” Pediatric Palliative Care Library, accessed October 11, 2024, https://pedpalascnetlibrary.omeka.net/items/show/18697.