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Discussing withdrawing and withholding of life-sustaining medical treatment in a tertiary paediatric hospital: a survey of clinician attitudes and practices.
Forbes, Tom; Goeman, Emma; Stark, Zornitza; Hynson, Jenny; Forrester, Mike.
Afiliação
  • Forbes T; Royal Children's Hospital, Melbourne, Victoria, Australia.
J Paediatr Child Health ; 44(7-8): 392-8, 2008.
Article em En | MEDLINE | ID: mdl-18638330
AIM: To better understand current attitudes and practices relating to discussions concerning the withholding and withdrawing of life-sustaining medical treatment (WWLSMT) among medical staff in the paediatric setting. METHODS: An anonymous online survey of paediatricians (senior medical staff - SMS) and paediatric trainees (junior medical staff - JMS) likely to be involved in the care of children with life limiting illness. RESULTS: A total of 162 responses were obtained (response rate 42%). SMS indicated feeling more comfortable with their abilities to discuss WWLSMT than JMS. Barriers to discussing WWLSMT were numerous and included clinician concerns about family readiness for the discussion, prognostic uncertainty, family disagreement with the treating team regarding the child's prognosis/diagnosis and concerns about how to manage family requests for treatments that are not perceived to be in the child's best interests. Fifty-eight per cent of JMS and 35.8% of SMS reported receiving no specific communication training regarding WWLSMT. Most learned through experience and by observing more senior colleagues. There was a high level of support for additional training in this area and for the provision of resources such as discussion guidelines and a structured form for documenting the outcomes WWLSMT discussions. CONCLUSION: The majority of JMS feel less comfortable with their abilities to facilitate these discussions than their senior colleagues. The results of this study suggest that although confidence correlates with experience, junior and senior clinicians are eager to improve their skills through ongoing professional development and the provision of resources. The education needs of JMS and SMS appear to be different.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Padrões de Prática Médica / Atitude do Pessoal de Saúde / Futilidade Médica / Suspensão de Tratamento / Hospitais Pediátricos Tipo de estudo: Guideline / Prognostic_studies / Qualitative_research Limite: Child / Humans País/Região como assunto: Oceania Idioma: En Revista: J Paediatr Child Health Assunto da revista: PEDIATRIA Ano de publicação: 2008 Tipo de documento: Article País de afiliação: Austrália

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Padrões de Prática Médica / Atitude do Pessoal de Saúde / Futilidade Médica / Suspensão de Tratamento / Hospitais Pediátricos Tipo de estudo: Guideline / Prognostic_studies / Qualitative_research Limite: Child / Humans País/Região como assunto: Oceania Idioma: En Revista: J Paediatr Child Health Assunto da revista: PEDIATRIA Ano de publicação: 2008 Tipo de documento: Article País de afiliação: Austrália