What influences parents??? decisions to limit or withdraw life support?*

Sharman, Mahesh; Meert, Kathleen L.; Sarnaik, Ashok P.

doi:10.1097/01.pcc.0000170616.28175.d9

Cited by 112 publications

(108 citation statements)

References 12 publications

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“…Many children were denied treatment or abandoned in the hospital with or without their mothers on account of this, despite international attention earlier drawn to this in a report by McVeigh 22 in The Observer. Similar to earlier reports in developed countries, 23,24 it is of note however that a large proportion of parents delayed signing informed consent due to strong attachment to an only child, recorded in 29 (10.3%) in this series. This was because they needed to be assured of their children' safety, while others 71 (25.3%) delayed in presenting because of guilt feelings for giving birth to a child with deformity.…”

Section: Discussionsupporting

confidence: 73%

Causes, Spectrum and Effects of Surgical Child Abuse and Neglect in a Nigerian City

Osifo¹,

Oku²

2010

West African Journal of Medicine

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BACKGROUND: Children are dependent on parents/care givers for the quality of health care services received and in developing countries, where they are not protected against child abuse; many die as a result of denial of appropriate treatment. OBJECTIVE: The objective of this study was to determine the causes, spectrum and effects of abuse/neglect on surgical children. METHODS: Analysis of cases of surgical child abuse/neglect between January, 1998 and December, 2007 at the University of Benin Teaching Hospital, Benin City, Nigeria, was done. RESULTS: A total of 281 children aged two days and 12 years comprising 113 males and 168 females with male/female ratio 1:1.4, mainly with congenital malformation, suffered surgical child abuse/neglect ranging from delayed presentation, to child abandonment which was perpetuated by ignorance, poverty, superstitious beliefs, customs as well as non availability of free medical services for children. Counselling and home visits in addition to surgeries were done and 198 (70.5%) children were successfully treated with those abandoned happily reunited with their families, while 56 (19.9%) mortality was recorded due to complications of the primary surgical pathology, and this was statistically significant compared with other children with similar lesions but without abuse or neglect during the period (P=0.0102). Whereas 27 (9.6%) among those discharged against medical advice were lost to follow-up, of the 198 children that survived, 22 suffered psychological trauma and were co-managed with psychologists while seven were transferred to orphanage homes. CONCLUSION: Surgical child abuse/neglect is rampant, hence, it is hoped that these findings will influence policy makers in this sub-region to formulate policies that will protect children against this form of child abuse.

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Section: Discussionsupporting

confidence: 73%

Causes, Spectrum and Effects of Surgical Child Abuse and Neglect in a Nigerian City

Osifo¹,

Oku²

2010

West African Journal of Medicine

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“…Although 54 units saw at least one death following enrolment in a trial, more than half (42/72, 58.3%) saw fewer than five deaths over this 5-year period (Table 10). Five Level 3 NICUs had larger numbers (n = 37, 29, 26, 22 and 20) and 30.9% of all deaths recorded by the units occurred in these five units. In around half of the units, the proportion of babies who died following trial enrolment was 20% or more (Table 11).…”

Section: Variation In Mortality Across Units (Unit-specific Mortality)mentioning

confidence: 99%

“…It can also be a challenging professional environment, [17][18][19][20][21][22] but clinicians build up expertise over time and often develop strategies to deal with and manage difficult situations. 23 Death in the NICU or PICU can bring with it a number of very difficult experiences for parents in addition to the loss of their child, such as end-of-life decision-making, [24][25][26][27][28][29][30] the experience of withdrawal of care and the impact of lingering death, 31,32 loss of a multiple (e.g. a twin or triplet) 28 and multiple losses, 33 and the need to consider post-mortem examinations 34 (for a review of studies of end-of-life decision-making in the NICU see Eden and Callister; 32 for decision-making more generally in the PICU, see Madrigal and colleagues 35 ).…”

Section: Experiences In Neonatal Intensive Care Units and Paediatric mentioning

confidence: 99%

Death, bereavement and randomised controlled trials (BRACELET): a methodological study of policy and practice in neonatal and paediatric intensive care trials

Snowdon

Brocklehurst

Tasker

et al. 2014

Health Technology Assessment

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“…For many neonatal cases, a high risk of poor outcome is determined and physicians are required to make decisions regarding treatment options [8][9][10]. The decision of WLSV for a neonate is affected by an interaction by an interaction of multiple factors such as the neonate's clinical condition, social factors, as well as family and healthcare provider values [11,12].…”

Section: Introductionmentioning

confidence: 99%

Defining the Threshold at which Health Care Professionals Consider Withdrawing Life Sustaining Ventilation in Neonatology

Shivananda

Lee²,

Marc-Aurele³

et al. 2013

J Palliat Care Med

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Objective: To determine the variation in healthcare provider perspectives regarding Withdrawing Life Sustaining Ventilation (WLSV) in Neonatology. Methods:We surveyed physicians, nurses, respiratory therapists, social workers, occupational and physical therapists, and neonatal pharmacists at two North American neonatal intensive care units to assess how neonatal healthcare providers use numerical risk to assist decision-making in Withdrawing Life Sustaining Ventilation. The survey presented nine scenarios depicting varying projected disabilities (single and multiple) at 3 years of age. Participants were asked to choose a predicted risk for the proposed disabilities (threshold) at which they would consider offering the WLSV option to parents. Ten additional questions regarding demographic information, attitudes, beliefs, and personal experiences were included. Results:The response rate was 59% (332/562). Respondents were primarily female nurses. For all respondents, the choice of WLSV was offered at statistically increasing frequency for the following disabilities: deafness, blindness, cerebral palsy, and mental retardation. The risk of severe mental retardation was the strongest influencing variable. The median choice for risk of severe mental retardation alone (61-70% risk) showed no significant difference from the median choice for risk of multiple disabilities (two or more). Median responses were not significantly different with respect to age, number of children, ethnic origin, occupation, religion, strength of religious belief, or knowledge of a friend/relative with impairments. Conclusions:Poor cognitive outcome is the principal determinant in WLSV decision-making among health care providers.

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What influences parents??? decisions to limit or withdraw life support?*

Cited by 112 publications

References 12 publications

Causes, Spectrum and Effects of Surgical Child Abuse and Neglect in a Nigerian City

Causes, Spectrum and Effects of Surgical Child Abuse and Neglect in a Nigerian City

Death, bereavement and randomised controlled trials (BRACELET): a methodological study of policy and practice in neonatal and paediatric intensive care trials

Defining the Threshold at which Health Care Professionals Consider Withdrawing Life Sustaining Ventilation in Neonatology

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