End-of-life care in the pediatric intensive care unit: Attitudes and practices of pediatric critical care physicians and nurses

Burns, Jeffrey P.; Mitchell, Christine; Griffith, John L.; Truog, Robert D.

doi:10.1097/00003246-200103000-00036

Cited by 123 publications

(109 citation statements)

References 34 publications

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“…Because the nurses are providing daily care, they are obviously involved; however, they sometimes carry out the end-of-life decision themselves and sometimes do so without the physician's presence. This finding is in accordance with results of another study 28 in which physicians were not always at the bedside when an end-of-life decision was carried out.…”

Section: Nurses' Attitudes Toward End-of-life Decisionssupporting

confidence: 91%

Medical End-of-Life Decisions: Experiences and Attitudes of Belgian Pediatric Intensive Care Nurses

Inghelbrecht¹,

Bilsen²,

Pereth³

et al. 2009

American Journal of Critical Care

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Objective To investigate Belgian pediatric intensive care nurses' involvement in and attitudes toward medical end-of-life decisions with a possible or certain life-shortening effect. Methods Questionnaires were distributed to 141 nurses working in 5 of the 7 pediatric intensive care units in Belgium. Nurses were asked to recall the last child in their care whose treatment involved an end-of-life decision and to describe anonymously their involvement in the decision. Attitudes were ascertained by means of statements and a Likert scale. Results Questionnaires were completed by 89 nurses (63%). During the preceding 2 years, 76 (85%) had cared for at least 1 child for whom a medical end-of-life decision had been made. Nurses were involved in initiating the decision in 17% of cases, participated in decision making in 50%, and played a role in carrying out the decision in 90%. Only 6% of nurses found it always ethically wrong to hasten the death of a child by administering lethal drugs; most nurses (78%) reported they were prepared to cooperate in administering life-ending drugs in some cases. Most (89%) favored adapting the law, making life termination of children legally possible in certain cases. Conclusions Belgian pediatric intensive care nurses are often involved in carrying out medical end-of-life decisions, including administration of life-ending drugs, whereas their participation in decision making is more limited. Most think that the current euthanasia law should be extended to minors so that administering life-ending drugs would be possible for terminally ill children in specific circumstances.

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Section: Nurses' Attitudes Toward End-of-life Decisionssupporting

confidence: 91%

Medical End-of-Life Decisions: Experiences and Attitudes of Belgian Pediatric Intensive Care Nurses

Inghelbrecht¹,

Bilsen²,

Pereth³

et al. 2009

American Journal of Critical Care

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“…The results support the lack of perceived influence of religion on decisionmaking found in previous reports 20,30,31 and differ from studies that report that physicians with <10 years of experience were more willing to withhold resuscitation due to parental request. 6,32 Limitations This study has several limitations.…”

Section: Other Influencessupporting

confidence: 74%

Decision-making in the delivery room: a survey of neonatologists

Binns

et al. 2007

J Perinatol

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Objective: To examine influences on neonatologists' decision-making regarding resuscitation of extremely premature infants.Study Design: A mailed survey of Illinois neonatologists evaluated influences on resuscitation. Personal and parentally opposed (that is, acting against parental wishes) gray zones of resuscitation were defined, with the lower limit (LL) the gestational age at or below which resuscitation would be consistently withheld and the upper limit (UL) above which resuscitation was mandatory.Result: Among the 85 respondents, LL and UL of the personal and parentally opposed gray zones were median 22 and 25 weeks, respectively. Neonatologists with an UL personal gray zone <25 completed weeks were significantly more fearful of litigation, more likely to have received didactic/continuing medical education teaching, and less likely to always consider parents' opinions in resuscitation decisions. Neonatologists with an UL parentally opposed gray zone <25 completed weeks were more fearful of litigation. Conclusion:Neonatologists perceive a 'gray zone' of resuscitative practices and should understand that external influences may affect their delivery room resuscitation practices.

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“…Higher rates of agreement were found in two surveys of PICU physicians in which about threequarters of respondents agreed that non-initiating is ethically the same as withdrawing a treatment. 10,11 A study of ten European countries' neonatologists showed only about one-third to one-half agreed that withdrawing and withholding treatment are ethically equivalent. 14 Which action neonatologists regard as more ethically or emotionally challenging is not clear by the responses, and deserves further study.…”

Section: Withholding Of Lsts Across Scenariosmentioning

confidence: 99%

“…[7][8][9] Several studies explore physicians' end-of-life (EOL) decision-making in pediatric intensive care units and in adult critical care settings. [10][11][12] However, an extensive review of the literature finds no similar studies of US neonatologists and finds only a few EOL surveys of neonatology outside the US. Little is known about neonatologists' views on limiting care outside of the delivery room, as most research focuses on managing the extremely premature or severely affected infant immediately after birth.…”

Section: Introductionmentioning

confidence: 99%

Survey of neonatologists’ attitudes toward limiting life-sustaining treatments in the neonatal intensive care unit

Feltman

Leuthner

2011

J Perinatol

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Objective: To understand neonatologists' attitudes toward end-of-life (EOL) management in clinical scenarios, EOL ethical concepts and resource utilization.Study Design: American Academy of Pediatrics (AAP) Perinatal section members completed an anonymous online survey. Respondents indicated preferences in limiting life-sustaining treatments in four clinical scenarios, ranked agreement with EOL-care ethics statements, indicated outside resources previously used and provided demographic information.Result: In all, 451 surveys were analyzed. Across clinical scenarios and as general ethical concepts, withdrawal of mechanical ventilation in severely affected patients was most accepted by respondents; withdrawal of artificial nutrition and hydration was least accepted. One-third of neonatologists did not agree that non-initiation of treatment is ethically equivalent to withdrawal. Around 20% of neonatologists would not defer care if uncomfortable with a parent's request. Respondents' resources included ethics committees, AAP guidelines and legal counsel/courts. Conclusion:Challenges to providing just, unified EOL care strategies are discussed, including deferring care, limiting artificial nutrition/hydration and conditions surrounding ventilator withdrawal.

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End-of-life care in the pediatric intensive care unit: Attitudes and practices of pediatric critical care physicians and nurses

Cited by 123 publications

References 34 publications

Medical End-of-Life Decisions: Experiences and Attitudes of Belgian Pediatric Intensive Care Nurses

Medical End-of-Life Decisions: Experiences and Attitudes of Belgian Pediatric Intensive Care Nurses

Decision-making in the delivery room: a survey of neonatologists

Survey of neonatologists’ attitudes toward limiting life-sustaining treatments in the neonatal intensive care unit

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