Parallel planning and the paediatric critical care patient

Abstract

A growing number of children with life-limiting conditions (LLCs) are being cared for in paediatric critical care (PCC) settings. Children with LLCs admitted to PCC are at a high risk of developing complications and many die after prolonged admissions. Relatively few of these patients and their parents or carers have had documented discussions about their wishes for care in the event of a serious clinical deterioration before admission to PCC. There is a need for improved understanding of (1) how parents arrive at decisions regarding what is best for their child at times of critical illness and (2) the role of parallel planning and advance care plans in that process. This review examines the complexities of decision-making in children with LLCs who are admitted to PCC settings.

Factors associated with health professionals decision to initiate paediatric advance care planning: A systematic integrative review

“…52 All the papers stemmed from developed countries, seven from the United States, 25,27,50,51,55,56,59 four from Australia 11,44,49,52 one each from Canada 58 and Germany, 24 two from Netherlands 47,48 and six studies from the United Kingdom. 15,45,46,53,54,57 Fourteen papers were empirical i.e. : quantitative (n = 8) 11,25,27,[48][49][50][51][52] of which one was a consensus-based method, 52 qualitative (n = 6).…”

“…The choice of the doctor to start such conversations was justified based on the evidence that although they felt discomfort addressing paediatric advance care planning 24,44,51,57,59 they were often more comfortable initiating discussions rather than nurses or psychosocial staff. 50,51 However, reticence on the part of the health professional, including doctors, to initiate conversations was evident.…”

“…The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by the UK Department of Employment and Learning (DEL) awarded to the lead author to undertake this research as part of a PhD. 25 ; Durall et al 27 ; De Vos et al 48 ; Kruse et al 51 ; Sidgwick et al 57 Haem/ Oncology wards 4 Sanderson et al 25 ; Durall et al 27 ; De Vos et al 48 ; Kruse et al 51 Neurology/ Metabolic 2 Hiscock and Barclay 45 ; De Vos et al 48 Whole Children's Hospital or no ward specified. 6 Basu and Swil 11 ; Lotz et al 24 ; Jack et al 46 ; Forbes et al 49 ; Harrison et al 50 ; Haynes et al 54 ; Zaal-Schuller et al 47 ; Bradford et al 52 Appendix 3.…”

“…It was perceived a correlation existed between increased clinical exposure, 11,49,57 knowledge and training, 50 regarding the attitude and ease of approach of the health professional. Doctors were often hesitant to take the lead citing a lack of knowledge and training as key reasons to avoid taking the role.…”

A systematic concept analysis of ‘technology dependent’: challenging the terminology

“…This may be explained by a priori beliefs of the value of a child's opinion or on limited belief of the importance of the chronological age or developing abilities of children as they age [60,61]. Literature that espouses increased autonomy of the child in decisionmaking argues that it can increase the child's trust and enhance the child-physician relationship [54,55,57,[62][63][64][65][66].…”