Consultation of parents and healthcare professionals in end-of-life decision-making for neonates and infants: a population-level mortality follow-back physician survey

Abstract

Background End-of-life decisions with potential life-shortening effect in neonates and infants are common. We aimed to evaluate how often and in what manner neonatologists consult with parents and other healthcare providers in these cases, and whether consultation is dependent on the type of end-of-life decision made. Methods Based on all deaths under the age of one that occurred between September 2016 and December 2017 in Flanders, Belgium, a nationwide mortality follow-back survey was performed. The survey asked about different types of end-of-life decisions, and whether and why parents and/or other healthcare providers had or had not been consulted. Results Response rate was 83% of the total population. End-of-life decisions in neonates and infants were consulted both with parents (92%) and other healthcare providers (90%), and agreement was reached between parents and healthcare providers in most cases (96%). When medication with an explicit life-shortening intent was administered parents were always consulted prior to the decision; however when medication without explicit life-shortening intention was administered parents were not consulted in 25% of the cases. Conclusions Shared decision-making between parents and physicians in case of neonatal or infant end-of-life decision-making is the norm in daily practice. All cases without parental consultation concerned non-treatment decisions or comfort medication without explicit life-shortening intention where physicians deemed the medical situation clear and unambiguous. However, we recommend to at least inform parents of medical options, and to explore other possibilities to engage parents in reaching a shared decision. Physicians consult other healthcare providers before making an end-of-life decision in most cases.

Cause of death and making end‐of‐life decisions in preterm infants has not changed over time: A mortality follow‐back survey

“…End-of-life decisions are an integral part of medical practice in critically ill neonates in Flanders. 21 In concordance with previous studies, NTD with parental involvement made up the largest proportion of end-of-life decisions and appear to have become more acceptable than 20 years ago. 15,22 Consistent with findings in international literature, withdrawal of ventilatory support was also in our study the most common NTD.…”

Application of cloud accounting in enterprise financial forecasting and decision making in the era of big data

“…With the gradual deepening of information technology in society, all enterprises cannot operate without the help of technology in their daily management [1]. The rapid forward movement of the Internet has enabled the financial decision-making process of enterprises to have technological innovations to a certain extent [2]. In the era of big data and cloud accounting, it is more important for staff in all industries to focus on the current information technology, to learn and enrich their professional knowledge continuously, to apply big data and cloud accounting in financial work, and to provide more accurate and useful financial information to those who need them to use [3][4].…”