The ethical challenges of palliative care from the perspectives of pediatricians: A qualitative study in Iran

Abstract

BackgroundAdherence to ethical principles is a requirement for palliative care delivery to children and a main concern of healthcare providers. Physicians usually face ethical challenges during their daily practice in hospitals and need adequate skills and the ability to identify and manage them. This study sought to explore the ethical challenges of palliative care from the perspectives of pediatricians.MethodsThis qualitative study was conducted between April and July 2019 using the content analysis approach. Participants were fifteen pediatric medical residents, specialists, and subspecialists purposively recruited from pediatric hospitals in Tehran, Iran. Data were collected using in-depth semi-structured interviews and were analyzed using Graneheim and Lundman's approach to conventional content analysis. Trustworthiness was ensured through the four criteria proposed by Guba and Lincoln.ResultsParticipants' experiences of the ethical challenges of palliative care for children were grouped into two main categories, namely “bewilderment in dealing with children and their families” (with two subcategories) and “conflicts in decision making” (with three subcategories). The final five subcategories were: (a) inability to effectively communicate with children and their families, (b) inability to tell the truth about the disease, (c) physician-parent conflicts, (d) parent-child conflicts, and (e) physician-physician conflicts.ConclusionThe main ethical challenges of palliative care from the perspectives of Iranian pediatricians are the inability to effectively communicate with children and their families, the inability to tell them the truth, and the inability to manage physician-parent, parent-child, and physician-physician conflicts. Identification and management of these challenges may help improve the quality of pediatric palliative care in Iran. Further studies are needed to confirm these findings in other settings.

Differences in the knowledge, attitudes, and needs of caregivers and healthcare providers regarding palliative care: a cross-sectional investigation in pediatric settings in China

“…According to reports, family members of 50% of PICU patients cannot understand the doctor’s explanations about the diagnosis, treatment, and prognosis of the patient’s disease. When the patient’s condition rapidly deteriorates, the family members lack sufficient understanding of the disease and cannot accept the facts, leading to medical disputes [ 54 , 55 ]. Most children with tumors and their families hope that doctors can truthfully inform them of their prognosis and final time of life.…”

“…Some patients with severe illnesses already consider palliative care issues such as death and medical decision-making, but due to clinical situations, information acquisition, and other reasons, they are unable to express their own demands [ 4 , 35 ]. Or, some family members may not be able to understand the special needs such as death [ 54 ]. For families who cannot accept illness and palliative care situations, healthcare providers continue to provide routine treatment and care in the hospital based on family treatment requirements.…”

Cardiopulmonary resuscitation in pediatric patients under palliative home care – A multicenter retrospective study

“…This might help to start advanced care planning and might offer the opportunity to accelerate decision-making. Although competent and respectful communication is provided to families with a child diagnosed with a life-limiting disease, a recent Iranian study on specialized pediatricians showed that communicating the truth about the patient's status remains a major problem ( 19 ). This can be caused by physician−parents, physician−patient, or physician−physician conflicts but also by language barriers and other cultural beliefs.…”

Parents' Protective Strategies in Dealing with Adolescence Cancer: A Qualitative Study

“…The patient was informed through the family. If the doctor was supposed to inform the patient, it would be done at the family's discretion and indirectly by expressing general concepts and cultural and social factors [25]. In this conscious approach, parents try to give hope to the Adolescence.…”