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Arch Pediatr Adolesc Med · Nov 2009
Parental views on withdrawing life-sustaining therapies in critically ill children.
- Kelly Nicole Michelson, Tracy Koogler, Christine Sullivan, María del Pilar Ortega, Emily Hall, and Joel Frader.
- Buehler Center on Aging, Health & Society, Children's Memorial Hospital, Division of Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60614, USA. kmichelson@childrensmemorial.org
- Arch Pediatr Adolesc Med. 2009 Nov 1;163(11):986-92.
ObjectiveTo broaden existing knowledge of pediatric end-of-life decision making by exploring factors described by parents of patients in the pediatric intensive care unit (PICU) as important/influential if they were to consider withdrawing life-sustaining therapies.DesignQuantitative and qualitative analysis of semi-structured one-on-one interviews.SettingThe PICUs at 2 tertiary care hospitals.ParticipantsEnglish- or Spanish-speaking parents who were older than 17 years and whose child was admitted to the PICU for more than 24 hours to up to 1 week.InterventionSemi-structured one-on-one interviews.ResultsForty of 70 parents (57%) interviewed said they could imagine a situation in which they would consider withdrawing life-sustaining therapies. When asked if specific factors might influence their decision making, 64% of parents said they would consider withdrawing life-sustaining therapies if their child were suffering; 51% would make such a decision based on quality-of-life considerations; 43% acknowledged the influence of physician-estimated prognosis in their decision; and 7% said financial burden would affect their consideration. Qualitative analysis of their subsequent comments identified 9 factors influential to parents when considering withdrawing life-sustaining therapies: quality of life, suffering, ineffective treatments, faith, time, financial considerations, general rejection of withdrawing life-sustaining therapies, mistrust/doubt toward physicians, and reliance on self/intuition.ConclusionParents describe a broad range of views regarding possible consideration of withdrawing life-sustaining therapies for their children and what factors might influence such a decision.
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