Sullivan Jane E, Gillam Lynn H, Monagle Paul T
The Children's Bioethics Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Centre for Health Equity, The University of Melbourne, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2020 Jul;56(7):1060-1065. doi: 10.1111/jpc.14816. Epub 2020 Feb 19.
Parents' role as end-of-life decision-makers for their child has become largely accepted Western health-care practice. How parents subsequently view and live with the end-of-life decision (ELD) they made has not been extensively examined. To help extend understanding of this phenomenon and contribute to care, as a part of a study on end-of-life decision-making, bereaved parents were asked about the aftermath of their decision-making.
A qualitative methodology was used. Semi-structured interviews were conducted with parents who had discussed ELDs for their child who had a life-limiting condition and had died. Data were thematically analysed.
Twenty-five bereaved parents participated. Results indicate that parents hold multi-faceted views about their decision-making experiences. An ELD was viewed as weighty in nature, with decisions judged against the circumstances that the child and parents found themselves in. Despite the weightiness, parents reflected positively on their decisions, regarding themselves as making the right decision. Consequently, parents' comments demonstrated being able to live with their decision. When expressed, regret related to needing an ELD, rather than the actual decision. The few parents who did not perceive themselves as their child's decision-maker subsequently articulated negative reactions. Enduring concerns held by some parents mostly related to non-decisional matters, such as the child's suffering or not knowing the cause of death.
Results suggest that parents can live well with the ELDs they made for their child. End-of-life decision-making knowledge is confirmed and extended, and clinical support for parents informed.
在西方医疗实践中,父母作为子女临终决策制定者的角色已在很大程度上得到认可。然而,父母在做出临终决策(ELD)后如何看待并接受这一决策,尚未得到广泛研究。作为临终决策研究的一部分,为了帮助扩展对这一现象的理解并为护理提供参考,我们询问了失去孩子的父母关于他们决策后的情况。
采用定性研究方法。对那些曾为患有危及生命疾病且已去世的孩子讨论过临终决策的父母进行了半结构化访谈。对数据进行了主题分析。
25位失去孩子的父母参与了研究。结果表明,父母对他们的决策经历持有多方面的看法。临终决策本质上被视为重大决策,其决策会根据孩子和父母所处的情况来评判。尽管决策重大,但父母对自己的决策给予了积极的反思,认为自己做出了正确的决定。因此,父母的评论表明他们能够接受自己的决策。当表达遗憾时,遗憾与需要做出临终决策有关,而非实际的决策本身。少数不认为自己是孩子决策制定者的父母随后表达了负面反应。一些父母持续关注的问题大多与非决策性事项有关,比如孩子的痛苦或不知道死亡原因。
结果表明,父母能够很好地接受他们为孩子做出的临终决策。临终决策知识得到了确认和扩展,并为父母提供了临床支持信息。