Curkovic Marko, Rubic Filip, Jozepovic Ana, Novak Milivoj, Filipovic-Grcic Boris, Mestrovic Julije, Lah Tomulic Kristina, Peter Branimir, Spoljar Diana, Grosek Štefan, Janković Sunčana, Vukovic Jurica, Kujundžić Tiljak Mirjana, Štajduhar Andrija, Borovecki Ana
University Psychiatric Hospital Vrapče, Zagreb, Croatia.
School of Medicine, University of Zagreb, Zagreb, Croatia.
Front Pediatr. 2024 Aug 12;12:1394071. doi: 10.3389/fped.2024.1394071. eCollection 2024.
This study explores healthcare professionals' perspectives on end-of-life care in pediatric intensive care units (ICUs) in Croatia, aiming to illuminate their experiences with such practices, underlying attitudes, and major decision-making considerations. Amid the high variability, complexity, and emotional intensity of pediatric end-of-life decisions and practices, understanding these perspectives is crucial for improving care and policies.
The study utilized a cross-sectional survey intended for physicians and nurses across all pediatric ICUs in Croatia. It included healthcare professionals from six neonatal and four pediatric ICUs in total. As the data from neonatal and pediatric ICUs were examined jointly, the term pediatric ICU was used to denominate both types of ICUs. A statistical analysis was performed using Python and JASP, focusing on professional roles, professional experience, and regional differences.
The study included a total of 103 participants (with an overall response rate-in relation to the whole target population-of 48% for physicians and 29% for nurses). The survey revealed diverse attitudes toward and experiences with various aspects of end-of-life care, with a significant portion of healthcare professionals indicating infrequent involvement in life-sustaining treatment (LST) limitation discussions and decisions, as well as somewhat ambiguous attitudes regarding such practices. Notably, discrepancies emerged between different professional roles and, in particular, regions, underscoring the high variability of LST limitation-related procedures.
The findings highlight a pressing need for more straightforward guidelines, legal frameworks, support mechanisms, and communication strategies to navigate the complex terrain of rather burdensome end-of-life pediatric care, which is intrinsically loaded with profound ethical quandaries.
本研究探讨了克罗地亚儿科重症监护病房（ICU）医护人员对临终关怀的看法，旨在阐明他们在这些实践中的经历、潜在态度以及主要决策考虑因素。在儿科临终决策和实践的高度变异性、复杂性和情感强度中，理解这些观点对于改善护理和政策至关重要。
该研究采用了一项横断面调查，面向克罗地亚所有儿科ICU的医生和护士。总共包括来自六个新生儿ICU和四个儿科ICU的医护人员。由于对新生儿ICU和儿科ICU的数据进行了联合检查，因此使用“儿科ICU”一词来指代这两种类型的ICU。使用Python和JASP进行了统计分析，重点关注专业角色、专业经验和地区差异。
该研究共纳入103名参与者（医生的总体回复率相对于整个目标人群为48%，护士为29%）。调查揭示了对临终关怀各个方面的不同态度和经历，很大一部分医护人员表示很少参与维持生命治疗（LST）限制的讨论和决策，并且对这些实践的态度有些模糊。值得注意的是，不同专业角色之间，特别是不同地区之间出现了差异，这突出了与LST限制相关程序的高度变异性。
研究结果凸显了迫切需要更直接的指南、法律框架、支持机制和沟通策略，以应对相当繁重的儿科临终关怀这一复杂领域，该领域本质上充满了深刻的伦理困境。
