Carr Karen, Hasson Felicity, McIlfatrick Sonja, Downing Julia
Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK.
International Children's Palliative Care Network, UK & Makerere University, Kampala, Uganda.
Palliat Med. 2021 Mar;35(3):503-528. doi: 10.1177/0269216320983197. Epub 2020 Dec 29.
Advance care planning for children with palliative care needs is an emotionally, legally and complex aspect of care, advocated as beneficial to children, families and health professionals. Evidence suggests healthcare professionals often avoid or delay initiation. An overview of evidence on the factors that influence and impact on the health care professional's initiation of paediatric advance care planning process is lacking.
To review and synthesise evidence on the factors associated with health care professional's decision to initiate paediatric advance care planning.
Systematic integrative review using constant comparison method.
Electronic databases (CINAHL, PubMed, PsycINFO, Ovid MEDLINE, EMBASE, Web of Science and Cochrane) using MeSH terms and word searches in Oct 2019. No limit set on year of publication or country. Grey literature searches were also completed.
The search yielded 4153 citations from which 90 full text articles were reviewed. Twenty-one met inclusion criteria consisting of quantitative ( = 8), qualitative ( = 6) and theoretical ( = 7) studies.Findings revealed overarching and interrelated themes '.
This review provides insights into the complexities and factors surrounding the initiation of advance care planning in paediatric practice. Uncertainty regarding prognosis, responsibility and unpredictable parental reactions result in inconsistent practice. Future research is required to inform intervention to assist health care professionals when initiating paediatric advance care planning conversations.
为有姑息治疗需求的儿童进行预先护理计划是护理工作中一个涉及情感、法律且复杂的方面，倡导其对儿童、家庭和医疗专业人员有益。有证据表明，医疗专业人员常常避免或推迟启动这一计划。目前缺乏关于影响医疗专业人员启动儿科预先护理计划过程的因素的证据综述。
回顾并综合关于与医疗专业人员决定启动儿科预先护理计划相关因素的证据。
采用持续比较法进行系统综合综述。
2019年10月使用医学主题词和关键词搜索电子数据库（CINAHL、PubMed、PsycINFO、Ovid MEDLINE、EMBASE、科学网和Cochrane）。对发表年份或国家不设限制。还完成了灰色文献搜索。
搜索共获得4153条引文，从中筛选出90篇全文进行综述。21篇符合纳入标准，包括定量研究（=8）、定性研究（=6）和理论研究（=7）。研究结果揭示了总体和相互关联的主题。
本综述深入探讨了儿科实践中启动预先护理计划所涉及的复杂性和因素。预后的不确定性、责任以及不可预测的父母反应导致实践不一致。未来需要开展研究以指导干预措施，帮助医疗专业人员启动儿科预先护理计划的对话。
