Pediatric advance care planning from the perspective of health care professionals: a qualitative interview study.
Pediatric advance care planning from the perspective of health care professionals: a qualitative interview study.
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DOI：
10.1177/0269216314552091
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发表时间：
2015-03
影响因子：
4.4
通讯作者：
Führer M
中科院分区：
文献类型：
--
作者：
Lotz JD;Jox RJ;Borasio GD;Führer M
儿科预先护理计划在几个方面与成人环境不同，包括患者的诊断，未成年人年龄和可疑的同意能力。到目前为止，研究在很大程度上忽视了专业人士的观点。我们的目的是调查的态度和需要的卫生保健专业人员与儿科预先护理计划。这是一个定性的访谈研究与专家在儿科临终关怀。进行了定性内容分析。我们进行了17个半结构化的采访，医疗保健专业人士照顾重病儿童/青少年，从不同的专业，护理环境和机构。儿科预先护理计划的感知问题与专业人员的不适和不确定性有关的生命结束的决定和预先指示。医生和非医疗保健提供者之间可能会发生冲突，因为双方都避免根据未成年人的预先指示承担治疗限制的责任。然而，儿科预先护理计划被认为是有益的，为每个人提供了一个行动计划，并确保患者/家长的愿望得到尊重。儿科预先护理计划的重要要求被确定为：与家庭反复讨论和共同决策，一个合格的主持人，确保整个过程的连续性，多专业会议，以及预先护理计划的专业教育。尽管认为需要儿科提前护理计划，但其实施的几个障碍被确定。这些结果仍有待于在更大的医疗保健专业人员队列中进行验证。未来的研究应侧重于制定和测试克服现有障碍的战略。
Pediatric advance care planning differs from the adult setting in several aspects, including patients’ diagnoses, minor age, and questionable capacity to consent. So far, research has largely neglected the professionals’ perspective. We aimed to investigate the attitudes and needs of health care professionals with regard to pediatric advance care planning. This is a qualitative interview study with experts in pediatric end-of-life care. A qualitative content analysis was performed. We conducted 17 semi-structured interviews with health care professionals caring for severely ill children/adolescents, from different professions, care settings, and institutions. Perceived problems with pediatric advance care planning relate to professionals’ discomfort and uncertainty regarding end-of-life decisions and advance directives. Conflicts may arise between physicians and non-medical care providers because both avoid taking responsibility for treatment limitations according to a minor’s advance directive. Nevertheless, pediatric advance care planning is perceived as helpful by providing an action plan for everyone and ensuring that patient/parent wishes are respected. Important requirements for pediatric advance care planning were identified as follows: repeated discussions and shared decision-making with the family, a qualified facilitator who ensures continuity throughout the whole process, multi-professional conferences, as well as professional education on advance care planning. Despite a perceived need for pediatric advance care planning, several barriers to its implementation were identified. The results remain to be verified in a larger cohort of health care professionals. Future research should focus on developing and testing strategies for overcoming the existing barriers.
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DOI：
10.1111/j.1532-5415.2004.52402.x
发表时间：
2004-09-01
影响因子：
6.3
作者：
Hickman, SE;Tolle, SW;Carley, MM
通讯作者：
Carley, MM
影响因子：
0.4
作者：
Jox, R. J.;Fuehrer, M.;Borasio, G. D.
通讯作者：
Borasio, G. D.
影响因子：
8
作者：
Durall, Amy;Zurakowski, David;Wolfe, Joanne
通讯作者：
Wolfe, Joanne
影响因子：
2.8
作者：
Groh, Gesa;Borasio, Gian Domenico;Fuehrer, Monika
通讯作者：
Fuehrer, Monika
影响因子：
26.1
作者：
Lyon, Maureen E.;Jacobs, Shana;Wang, Jichuan
通讯作者：
Wang, Jichuan