Life-sustaining treatment decisions in pediatric intensive care: an Italian survey on ethical concerns

Italian Journal of Pediatrics

Chiara Tosin¹  Amabile Bonaldi¹  Paolo Biban¹  Franco A. Carnevale²  Silvia Maria Modesta Pulitanò³  Angela Amigoni⁴  Andrea Pettenazzo⁴  Costanza Cecchi⁵  Alberto Giannini⁶  Elena Bravi⁷ 

[1] Department of Neonatal and Pediatric Critical Care, Verona University Hospital, Verona, Italy;McGill University/Montreal Children’s Hospital, Montreal, 680 Sherbrooke St. West, Suite 1836, H3A 2M7, Montréal, Quebec, Canada;Pediatric Intensive Care Unit Trauma Center Pediatric, F. Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy;Pediatric Intensive Care Unit, Department of Woman’s and Child’s Health, University Hospital of Padova, Padua, Italy;Pediatric Intensive Care Unit, Meyer Children’s Hospital, Florence, Italy;S.C. Anestesia e Rianimazione Pediatrica, Ospedale dei Bambini, ASST Spedali Civili di Brescia, Brescia, Italy;U.O. Psicologia, Azienda Provinciale Servizi Sanitari, Trento, Italy;

关键词: Ethics;    Critical care;    Intensive care;    Italy;    Life-sustaining treatment decisions;    Pediatric;   

DOI  :  10.1186/s13052-021-01054-z

来源: Springer

【 摘 要 】

ObjectivesTo investigate how life-sustaining treatment (LST) decisions are made and identify problematic ethical concerns confronted by physicians and nurses in pediatric intensive care within Italy.MethodsAn 88-question online survey was created, based on a previous qualitative study conducted by this team. The survey was designed to identify how LST decisions were managed; contrasting actual practices with what participants think practices should be. Replies from physicians and nurses were compared, to identify potential inter-professional ethical tensions. The study also identified participants’ principal ethical concerns. Moreover, open-ended questions elicited qualitative perspectives on participants’ views. The survey was pilot-tested and refined before initiation of the study.Results31 physicians and 65 nurses participated in the study. Participants were recruited from pediatric intensive care units across five Italian cities; i.e., Florence, Milan, Padua, Rome, Verona. Statistically significant differences were identified for (a) virtually all questions contrasting actual practices with what participants think practices should be and (b) 14 questions contrasting physician replies with those of nurses. Physicians and nurses identified the absence of legislative standards for LST withdrawal as a highly problematic ethical concern. Physicians also identified bearing responsibility for LST decisions as a major concern. Qualitative descriptions further demonstrated that these Italian pediatric intensive care clinicians encounter significantly distressing ethical problems in their practice.ConclusionsThe results of this study highlight a need for the development of (a) strategies for improving team processes regarding LST decisions, so they can be better aligned with how clinicians think decisions should be made, and (b) Italian LST decision-making standards that can help ensure optimal ethical practices.

【 授权许可】

CC BY