Children's Bioethics Centre, Royal Children's Hospital, , Melbourne, Victoria, Australia.
Arch Dis Child. 2014 Mar;99(3):216-20. doi: 10.1136/archdischild-2013-304249. Epub 2013 Dec 5.
End-of-life decision-making is difficult for everyone involved, as many studies have shown. Within this complexity, there has been little information on how parents see the role of doctors in end-of-life decision-making for children. This study aimed to examine parents' views and experiences of end-of-life decision-making.
A qualitative method with a semistructured interview design was used.
Parent participants were living in the community.
Twenty-five bereaved parents.
Parents reported varying roles taken by doctors: being the provider of information without opinion; giving information and advice as to the decision that should be taken; and seemingly being the decision maker for the child. The majority of parents found their child's doctor enabled them to be the ultimate decision maker for their child, which was what they very clearly wanted to be, and consequently enabled them to exercise their parental autonomy. Parents found it problematic when doctors took over decision-making. A less frequently reported, yet significant role for doctors was to affirm decisions after they had been made by parents. Other important aspects of the doctor's role were to provide follow-up support and referral.
Understanding the role that doctors take in end-of-life decisions, and the subsequent impact of that role from the perspective of parents can form the basis of better informed clinical practice.
正如许多研究表明,临终决策对所有相关人员来说都是困难的。在这种复杂性中,关于父母如何看待医生在儿童临终决策中的角色的信息很少。本研究旨在探讨父母对临终决策的看法和经验。
采用定性方法和半结构式访谈设计。
父母参与者居住在社区中。
25 名丧亲父母。
父母报告了医生的不同角色:作为没有意见的信息提供者;就应采取的决定提供信息和建议;以及似乎是孩子的决策者。大多数父母发现他们孩子的医生使他们能够成为孩子的最终决策者,这正是他们非常希望的,从而使他们能够行使父母的自主权。当医生接管决策时,父母发现这有问题。医生的另一个角色不太常见,但却很重要,即确认父母做出的决定。医生角色的其他重要方面是提供后续支持和转介。
了解医生在临终决策中所扮演的角色,以及从父母的角度来看,这种角色的后续影响,可以为更明智的临床实践提供基础。