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Boize P, Garner Y, Neaud E, Borrhomee S. RE-Re: Parents' participation in collegial meetings to discuss withholding or withdrawing treatment for their newborn: Working to improve information-sharing. Arch Pediatr 2024:S0929-693X(24)00076-9. [PMID: 38806379 DOI: 10.1016/j.arcped.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 04/16/2024] [Indexed: 05/30/2024]
Affiliation(s)
- P Boize
- Neonatal Intensive Care Unit, Hôpital Novo, 6 avenue Île de France 95300 Pontoise, France.
| | - Y Garner
- Clinical Psychologist, Reception and Care Unit for Deaf Patients, Mother-Child Unit, CH Annecy-Genevois, 1 avenue de l'hôpital 74370 Eragny Metz-Tessy, France
| | - E Neaud
- Neonatal Intensive Care Unit, Hôpital Novo, 6 avenue Île de France 95300 Pontoise, France
| | - S Borrhomee
- Neonatal Intensive Care Unit, Hôpital Novo, 6 avenue Île de France 95300 Pontoise, France
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Saint Denny K, Lamore K, Nandrino JL, Rethore S, Prieur C, Mur S, Storme L. Parents' experiences of palliative care decision-making in neonatal intensive care units: An interpretative phenomenological analysis. Acta Paediatr 2024; 113:992-998. [PMID: 38229540 DOI: 10.1111/apa.17109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/18/2023] [Accepted: 01/08/2024] [Indexed: 01/18/2024]
Abstract
AIM This work explores the experiences and meaning attributed by parents who underwent the decision-making process of withholding and/or withdrawing life-sustaining treatment for their newborn. METHODS Audio-recorded face-to-face interviews were led and analysed using interpretative phenomenological analysis. Eight families (seven mothers and five fathers) whose baby underwent withholding and/or withdrawing of life-sustaining treatment in three neonatal intensive care units from two regions in France were included. RESULTS The findings reveal two paradoxes within the meaning-making process of parents: role ambivalence and choice ambiguity. We contend that these paradoxes, along with the need to mitigate uncertainty, form protective psychological mechanisms that enable parents to cope with the decision, maintain their parental identity and prevent decisional regret. CONCLUSION Role ambivalence and choice ambiguity should be considered when shared decision-making in the neonatal intensive care unit. Recognising and addressing these paradoxical beliefs is essential for informing parent support practices and professional recommendations, as well as add to ethical discussions pertaining to parental autonomy and physicians' rapport to uncertainty.
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Affiliation(s)
- Kelly Saint Denny
- Department of Neonatology, Lille University Hospital, Lille, France
- Cognitive and Affective Sciences, SCALab UMR CNRS 9193, University of Lille, Lille, France
| | - Kristopher Lamore
- Cognitive and Affective Sciences, SCALab UMR CNRS 9193, University of Lille, Lille, France
| | - Jean-Louis Nandrino
- Cognitive and Affective Sciences, SCALab UMR CNRS 9193, University of Lille, Lille, France
| | - Sabine Rethore
- Department of Neonatology, Valenciennes Hospital, Valenciennes, France
| | - Charlotte Prieur
- Regional Resource Team for Pediatric Palliative Care, Lille University Hospital, Lille, France
- Department of Neonatology, Lens Hospital, Lens, France
| | - Sebastien Mur
- Department of Neonatology, Lille University Hospital, Lille, France
| | - Laurent Storme
- Department of Neonatology, Lille University Hospital, Lille, France
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Boize P, Garner Y, Neaud E, Borrhomee S. Parents' participation in collegial meetings to discuss withholding or withdrawing treatment for their newborn: Working to improve information-sharing. Arch Pediatr 2024; 31:95-99. [PMID: 38262860 DOI: 10.1016/j.arcped.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/23/2023] [Accepted: 10/21/2023] [Indexed: 01/25/2024]
Abstract
AIM The role of parents in decision-making concerning their child's end-of-life care is not clearly defined. Their participation is encouraged by ethical reflection, in particular by the CCNE (French National Ethics Advisory Committee), but laws are limited to imposing a duty to provide information to doctors. Decisions are taken at the end of a collegial meeting (CM) intended to better inform the child's referring physician (RP) who is in charge of the final decision following the French law. The aim of this study was to describe the support provided to bereaved families after they had been invited to attend a CM concerning their child, if they so wished. Additional aims were to determine the differences resulting from their acceptance or their refusal to participate as regards their perception of their child's history and as regards their grieving process. MATERIAL AND METHOD We conducted a retrospective study of all CMs held between November 2016 and May 2021, drawing a distinction between proposals made or not made to parents and their decision to accept or refuse. RESULTS In total, 49 CMs concerning 46 children were held during the study period. The proposal was not made to the parents in three cases; the parents chose to be present in 28 cases. The psychological follow-up (15/28 parents attending, 10/16 parents absent) illustrated that their presence enabled them to reflect on their child's death after having listened to and understood the reasons why it happened. They did not dispute the team's approach or decisions taken. CONCLUSION It is possible to include parents in CMs if they so wish. It would appear more beneficial than merely providing them with the information required. Studies must be carried out to ensure potential long-term benefit.
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Affiliation(s)
- Philippe Boize
- Neonatal Intensive Care Unit, Hôpital NOVO, 6 avenue Île de France 95300 Pontoise, France.
| | - Yaëlle Garner
- Clinical psychologist, reception and care unit for deaf patients, mother-child unit, CH ANNECY-GENEVOIS, 1 avenue de l'hôpital 74370 Eragny Metz-Tessy, France
| | - Enora Neaud
- Neonatal Intensive Care Unit, Hôpital NOVO, 6 avenue Île de France 95300 Pontoise, France
| | - Suzanne Borrhomee
- Neonatal Intensive Care Unit, Hôpital NOVO, 6 avenue Île de France 95300 Pontoise, France
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Morillo Palomo A, Esquerda Aresté M, Riverola de Veciana A, Cambra Lasaosa FJ. End-of-life decision-making in the neonatal intensive care unit. Front Pediatr 2024; 11:1352485. [PMID: 38259598 PMCID: PMC10800896 DOI: 10.3389/fped.2023.1352485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
Most paediatric deaths occur in the neonatal period, many of them in neonatal intensive care units after withdrawal of life support or the decision not to initiate new treatments. In these circumstances, discussions with families and decision-making are fundamental elements of the care and attention given to newborn babies. In this context, bioethical deliberation can help us to identify the values at stake, the different courses of action to be taken, and the means to ensure that family-shared decision-making is appropriate to the patient's situation and in accordance with the family's values.
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Affiliation(s)
- Ana Morillo Palomo
- Neonatal Intensive Care Unit, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Montse Esquerda Aresté
- Institut Borja de Bioètica, Universitat Ramon Llull, Barcelona, Spain
- School of Medicine, University of Lleida, Lleida, Spain
| | | | - Francisco José Cambra Lasaosa
- Institut Borja de Bioètica, Universitat Ramon Llull, Barcelona, Spain
- Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Barcelona, Spain
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Schneider K, Roll S, Tissen-Diabaté T, Bührer C, Garten L. Public Attitudes Toward Ethics and Practices in End-of-Life Decision-Making for Neonates. JAMA Netw Open 2024; 7:e2353264. [PMID: 38270948 PMCID: PMC10811557 DOI: 10.1001/jamanetworkopen.2023.53264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/05/2023] [Indexed: 01/26/2024] Open
Abstract
Importance Attitudes toward end-of-life decision-making in neonatology have been studied in physicians and other health care professionals and are mostly shaped by their clinical education and work experiences. In contrast, attitudes among the general public have not yet been investigated. Objective To assess (1) attitudes in the general public toward euthanasia and withdrawal of life-prolonging treatment in neonates with severe life-limiting conditions, (2) knowledge of current German recommendations, and (3) values in the German society regarding ethical issues and proxy decisions at the beginning of life. Design, Setting, and Participants This cross-sectional study was performed in Germany and used an exploratory design to analyze responses to an interview conducted by an independent, established commissioned polling institute in March and April 2022. Participants were 16 years or older, with German language fluency and comprehension and living in Germany. Main Outcomes and Measures Knowledge about recommendations for euthanasia and withdrawal of life-prolonging treatment as well as personal attitudes toward (1) euthanasia and withdrawal of life-prolonging treatment and (2) surrogate end-of-life decision-making for newborn infants were assessed. Results The study included 2116 participants (1077 females [50.9%]; mean [SD] age 52.1 [18.7] years). Of the participants, 16.8% (311 of 1851) reported knowing the German recommendations for euthanasia and withdrawal of life-prolonging treatment for neonates. Euthanasia and withdrawal of life-prolonging treatment were supported by 64.7% (1369 of 2116) and 77.9% (1649 of 2116) of respondents, respectively. Shared decision-making between parents and physicians for neonates in end-of-life situations was supported by 65.6% of participants (1388). In situations where shared decision-making was not possible, 73.4% of respondents (1019 of 1388) put the ultimate decision to the parents. The magnitude of the associations was low between sociodemographic factors and views on ethical issues and customary practices involved in end-of-life decisions for neonates. Conclusions and Relevance Results of this cross-sectional study suggested that most respondents were not aware of the national German recommendations for euthanasia and withdrawal of life-prolonging treatment for sick and extremely preterm newborns. When counseling parents of periviable newborns, clinicians may need to exert more effort in explaining the legal and ethical framework; a highly individualized approach is warranted.
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Affiliation(s)
- Katja Schneider
- Department of Neonatology, Gemeinnützige Gesellschaft der Franziskanerinnen zu Olpe, Marien-Hospital, Bonn, Germany
- Department of Neonatology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Stephanie Roll
- Institute of Social Medicine, Epidemiology and Health Economics, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Tatjana Tissen-Diabaté
- Institute of Social Medicine, Epidemiology and Health Economics, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Lars Garten
- Department of Neonatology, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Cambonie G, Desage C, Thaller P, Lemaitre A, de Balanda KB, Combes C, Gavotto A. Context of a neonatal death affects parental perception of end-of-life care, anxiety and depression in the first year of bereavement. BMC Palliat Care 2023; 22:58. [PMID: 37173678 PMCID: PMC10182590 DOI: 10.1186/s12904-023-01183-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Neonatal death is often preceded by end-of-life medical decisions. This study aimed to determine whether the context of death - after a decision of withholding or withdrawing life-sustaining treatment (WWLST) or despite maximum care - was associated with subsequent risk of parental anxiety or depression. The secondary objective was to assess parents' perceptions of end-of-life care according to death context. METHODS Prospective single center observational study of all neonatal deaths in a neonatal intensive care unit over a 5-year period. Data were collected during hospitalization and from face-to-face interviews with parents 3 months after the infant's death. Anxiety and depression were assessed using Hospital Anxiety and Depression Scale (HADS) questionnaires, completed by parents 5 and 15 months after death. RESULTS Of 179 deaths, 115 (64%) occurred after the WWLST decision and 64 (36%) despite maximum care. Parental satisfaction with newborn care and received support by professionals and relatives was higher in the first condition. Sixty-one percent of parents (109/179) attended the 3-month interview, with the distribution between groups very close to that of hospitalization. The completion rates of the HADS questionnaires by the parents who attended the 3-month interview were 75% (82/109) at 5 months and 65% (71/109) at 15 months. HADS scores at 5 months were consistent with anxiety in at least one parent in 73% (60/82) of cases and with depression in 50% (41/82). At 15 months, these rates were, respectively, 63% (45/71) and 28% (20/71). Risk of depression at 5 months was lower after a WWLST decision (OR 0.35 [0.14, 0.88], p = 0.02). Explicit parental agreement with the WWLST decision had an equivocal impact on the risk of anxiety at 5 months, being higher when expressed during hospitalization, but not at the 3-month interview. CONCLUSIONS Context of death has a significant impact on the emotional experience of parents after neonatal loss, which underlines the importance of systematic follow-up conversations with bereaved parents.
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Affiliation(s)
- Gilles Cambonie
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France.
- Pathogenesis and Control of Chronic Infection, UMR 1058, INSERM, University of Montpellier, Montpellier, France.
| | - Chloé Desage
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
| | - Pénélope Thaller
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
| | - Anne Lemaitre
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
| | - Karine Bertran de Balanda
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
| | - Clémentine Combes
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
| | - Arthur Gavotto
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
- PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
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Dombrecht L, Beernaert K, Chambaere K, Cools F, Goossens L, Naulaers G, Cornette L, Laroche S, Theyskens C, Vandeputte C, Van de Broek H, Cohen J, Deliens L. End-of-life decisions in neonates and infants: a nationwide mortality follow-back survey. BMJ Support Palliat Care 2022:bmjspcare-2021-003357. [PMID: 35459686 DOI: 10.1136/bmjspcare-2021-003357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/12/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Neonatology has undergone important clinical and legal changes; however, the implications for end-of-life decision-making in seriously ill neonates to date are unknown. Our aim was to examine changes in prevalence and characteristics of end-of-life decisions (ELDs) in neonatology. METHODS We performed a nationwide mortality follow-back survey in August 1999 to July 2000 and September 2016 to December 2017 in Flanders, Belgium. Data were linked to information from death certificates. For each death under the age of 1, physicians were asked to complete an anonymous questionnaire about which ELDs were made preceding death. RESULTS The response rate was 87% in 1999-2000 (253/292) and 83% in 2016-2017 (229/276). The proportion of deaths of infants born before 26 weeks' gestation was increased (14% vs 34%, p=0.001). Prevalence of ELDs remained stable at 60%, with non-treatment decisions occurring in about 35% of all deaths. Use of medication with an explicit life-shortening intention was prevalent in 7%-10% of all deaths. In early neonatal death (<7 days old) medication with an explicit life-shortening intention decreased from 12% to 6%, in late neonatal death (7-27 days old), it increased from 0% to 26%, and in postneonatal death (>27 days old), it increased from 2% to 10%. CONCLUSIONS Over a timespan of 17 year, the prevalence of neonatal ELDs has remained stable. A substantial number of deaths was preceded by the intentionally hastening of death by administrating medication. While surveying solely the physician perspective in this paper, there is a need for an open multidisciplinary debate, including, for example, nursing staff and family members, based on clinical as well as ethical and jurisdictional reflections to discuss the need for international guidelines.
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Affiliation(s)
- Laure Dombrecht
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kim Beernaert
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Filip Cools
- Department of Neonatology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Linde Goossens
- Department of Neonatology, University Hospital Ghent, Gent, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Luc Cornette
- Department of Neonatology, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | - Sabrina Laroche
- Department of Neonatology, University Hospital Antwerp, Edegem, Belgium
| | - Claire Theyskens
- Department of Neonatology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
| | - Christine Vandeputte
- Department of Neonatology, GZA Ziekenhuizen Campus Sint-Augustinus, Wilrijk, Belgium
| | - Hilde Van de Broek
- Department of Neonatology, ZNA Middelheim, Antwerpen, Antwerpen, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Ghent, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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8
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de Barbeyrac C, Roth P, Noël C, Anselem O, Gaudin A, Roumegoux C, Azcona B, Castel C, Noret M, Letamendia E, Stirnemann J, Ville Y, Lapillonne A, Viallard ML, Kermorvant-Duchemin E. The role of perinatal palliative care following prenatal diagnosis of major, incurable fetal anomalies: a multicentre prospective cohort study. BJOG 2021; 129:752-759. [PMID: 34665920 DOI: 10.1111/1471-0528.16976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe prenatal decision-making processes and birth plans in pregnancies amenable to planning perinatal palliative care. DESIGN Multicentre prospective observational study. SETTING Nine Multidisciplinary Centres for Prenatal Diagnosis of the Paris-Ile-de-France region. POPULATION All cases of major and incurable fetal anomaly eligible for TOP where limitation of life-sustaining treatments for the neonate was discussed in the prenatal period between 2015 and 2016. METHODS Cases of congenital defects amenable to perinatal palliative care were prospectively included in each centre. Prenatal diagnosis, decision-making process, type of birth plan, birth characteristics, pregnancy and neonatal outcome were collected prospectively and anonymously. MAIN OUTCOME MEASURE Final decision reached following discussions in the antenatal period. RESULTS We identified 736 continuing pregnancies with a diagnosis of a severe fetal condition eligible for TOP. Perinatal palliative care was considered in 102/736 (13.9%) pregnancies (106 infants); discussions were multidisciplinary in 99/106 (93.4%) cases. Prenatal birth plans involved life-sustaining treatment limitation and comfort care in 73/736 (9.9%) of the pregnancies. The main reason for planning palliative care at birth was short-term inevitable death in 39 cases (53.4%). In all, 76/106 (71.7%) infants were born alive, and 18/106 (17%) infants were alive at last follow-up, including four with a perinatal palliative care birth plan. CONCLUSIONS Only a small proportion of severe and incurable fetal disorders were potentially amenable to limitation of life-sustaining interventions. Perinatal palliative care may not be considered a universal alternative to termination of pregnancy. TWEETABLE ABSTRACT Perinatal palliative care is planned in 10% of continuing pregnancies with a major and incurable fetal condition eligible for TOP.
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Affiliation(s)
- C de Barbeyrac
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - P Roth
- Department Obstetrics and Fetal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, EA7328, Paris, France
| | - C Noël
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - O Anselem
- Department of Department Obstetrics and Fetal Medicine, AP-HP, Hôpital Cochin - Port-Royal, Paris, France
| | - A Gaudin
- Department of Neonatal Medicine, AP-HP, Hôpital Robert-Debré, Paris, France
| | - C Roumegoux
- Department of Neonatal Medicine, AP-HP, Hôpital Jean-Verdier, Bondy, France
| | - B Azcona
- Department of Neonatal Medicine, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - C Castel
- Department of Neonatal Medicine, Centre Hospitalier Intercommunal de Poissy-Saint-Quentin, Poissy, France
| | - M Noret
- Department of Obstetrics, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - E Letamendia
- Maternity Unit, AP-HP, Hôpital Antoine Béclère, Clamart, France
| | - J Stirnemann
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - Y Ville
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - A Lapillonne
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - M-L Viallard
- Palliative Medicine Unit, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - E Kermorvant-Duchemin
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
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Dagla M, Petousi V, Poulios A. Neonatal End-of-Life Decision Making: The Possible Behavior of Greek Physicians, Midwives, and Nurses in Clinical Scenarios. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083938. [PMID: 33918554 PMCID: PMC8069263 DOI: 10.3390/ijerph18083938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022]
Abstract
Background: This study investigates the acceptability, bioethical justification, and determinants of the provision of intensive care to extremely preterm or ill neonates among healthcare professionals serving in NICUs in Greek hospitals. Methods: Healthcare professionals (71 physicians, 98 midwives, and 82 nurses) employed full-time at all public Neonatal Intensive Care Units (NICUs) (n = 17) in Greece were asked to report their potential behavior in three clinical scenarios. Results: The majority of healthcare professionals would start and continue intensive care to (a) an extremely preterm neonate, (b) a full-term neonate with an unfavorable prognosis, and (c) a neonate with complete phocomelia. In cases (a) and (b), midwives and nurses compared to physicians (p = 0.009 and p = 0.004 in scenarios (a) and (b), respectively) and health professionals ascribing to the quality-of-life principle compared to those ascribing to the intrinsic value of life (p = 0.001 and p = 0.01 scenarios (a) and (b) respectively), tend towards withholding or withdrawing care. Religion plays an important role in all three scenarios (p = 0.005, p = 0.017 and p = 0.043, respectively). Conclusions: Understanding healthcare professionals’ therapeutic intensiveness in the face of NICU ethical dilemmas can improve NICU policies, support strategies, and, consequently, the quality of neonatal intensive care.
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Affiliation(s)
- Maria Dagla
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
- Correspondence: (M.D.); (V.P.)
| | - Vasiliki Petousi
- Department of Sociology, University of Crete, 74100 Crete, Greece
- Correspondence: (M.D.); (V.P.)
| | - Antonios Poulios
- Department of Psychology, National Kapodestrian University, 10679 Athens, Greece;
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Bioethical Decisions in Neonatal Intensive Care: Neonatologists' Self-Reported Practices in Greek NICUs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103465. [PMID: 32429230 PMCID: PMC7277706 DOI: 10.3390/ijerph17103465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 01/27/2023]
Abstract
This study presents, for the first time, empirical data on practices regarding bioethical decision-making in treatment of preterm and ill newborns in Greece. The aim of the study was to: (a) record self-reported practices and involvement of Greek physicians in decisions of withholding and withdrawing neonatal intensive care, and (b) explore the implication of cultural, ethical, and professional parameters in decision-making. Methods: 71 physicians, employed fulltime in all public Neonatal Intensive Care Units (NICUs) (n = 17) in Greece, completed an anonymous questionnaire between May 2009 and May 2011. Results: One-third of the physicians in our sample admitted that they have, at least once in the past, decided the limitation of intensive care of a newborn close to death (37.7%) and/or a newborn with unfavorable neurological prognosis (30.8%). The higher the physicians’ support towards the value of quality of human life, the more probable it was that they had taken a decision to withhold or withdraw neonatal intensive care (p < 0.05). Conclusions: Our research shows that Greek NICU physicians report considerably lower levels of ethical decision-making regarding preterm and ill newborns compared to their counterparts in other European countries. Clinical practices and attitudes towards ethical decision-making appear to be influenced mainly by the Greek physicians’ values.
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Abdel Razeq NM, Alduraidi H, Halasa S, Cuttini M. Clinicians' Self-Reported Practices Related to End-of-Life Care for Infants in NICUs in Jordan. J Obstet Gynecol Neonatal Nurs 2019; 49:78-90. [PMID: 31811824 DOI: 10.1016/j.jogn.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine how clinical decisions are made at the end of life for infants born with specific fatal and disabling conditions in NICUs in Jordan from the perspectives of neonatal health care providers. DESIGN A cross-sectional survey of neonatal nurses and physicians. SETTING Twenty-four NICUs in Jordan. PARTICIPANTS Participants included 213 nurses and 75 physicians who provided direct care for infants in NICUs. METHODS Using the EURONIC questionnaire, we asked participants to recall the last experiences of end-of-life decision making in which they were involved. The participants described factors and outcomes related to those experiences, and we used descriptive and inferential statistics to examine these factors. RESULTS In 83% of the recalled situations, the physicians in charge of the infants' care or who were on duty were the primary decision makers. Parents, nurses, ethics committees, and NICU heads were less involved. The infants' primary diagnoses were significantly associated with the nature of decisions regarding end-of-life care (p < .001). Age, importance of religion, having their own children, and involvement in research activities were factors that significantly predicted nurses' perceived levels of involvement in decision making (χ2[4] = 23.140, p < .001). CONCLUSION Our results suggest the need to improve clinical approaches to decision making regarding end-of-life care for infants in NICUs in Jordan to be more family focused and team based. This process should include parents, physicians, neonatal nurses, and ethics committees.
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