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Masri C, Farrell CA, Lacroix J, Rocker G, Shemie SD. Decision Making and End-of-Life Care in Critically Ill Children. J Palliat Care 2019. [DOI: 10.1177/082585970001601s09] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives 1) To comment on the medical literature on decision making regarding end-of-life therapy, 2) to analyze the data on disagreement about such therapy, including palliative care, and withholding and withdrawal practices for critically ill children in the pediatric intensive care unit (PICU), and 3) to make some general recommendations. Data Sources and Study Selection All papers published in peer-reviewed journals, and all chapters on end-of-life therapy, or on conflict between parents and caregivers about end-of-life decisions in the PICU were retrieved. Results We found three case series, three systematic descriptive studies, two qualitative studies, four surveys, and many legal opinions, editorials, reviews, guidelines, and book chapters. The main determinants of end-of-life decisions are the child's age, premorbid cognitive condition and functional status, pain or discomfort, probability of survival, and quality of life. Risk factors in persistent conflict between parents and caregivers about end-of-life care include a grave underlying condition or an unexpected and severe event. Conclusion Making decisions about end-of-life care is a frequent event in the PICU. Children may need both intensive care and palliative care concurrently at different stages of their illness. Disagreements are more likely to be resolved if the root cause of the conflict is better understood.
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Affiliation(s)
- Christian Masri
- Pediatric Intensive Care Unit, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montreal, Quebec
| | - Catherine Ann Farrell
- Pediatric Intensive Care Unit, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montreal, Quebec
| | - Jacques Lacroix
- Pediatric Intensive Care Unit, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montreal, Quebec
| | - Graeme Rocker
- Department of Medicine, The Queen Elizabeth II Health Center, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Sam D. Shemie
- Pediatric Intensive Care Unit, The Hospital For Sick Children, and Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
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