Parental views on withdrawing life-sustaining therapies in critically ill children

Michelson, K. N.; Koogler, T.; Sullivan, C.; Ortega Mdel, P.; Hall, E.; Frader, J.

Arch Pediatr Adolesc Med. 2009 Nov 4; 163(11):986-92

Abstract

OBJECTIVE: To broaden existing knowledge of pediatric end-of-life decision making by exploring factors described by parents of patients in the pediatric intensive care unit (PICU) as important/influential if they were to consider withdrawing life-sustaining therapies. DESIGN: Quantitative and qualitative analysis of semi-structured one-on-one interviews. SETTING: The PICUs at 2 tertiary care hospitals. PARTICIPANTS: English- or Spanish-speaking parents who were older than 17 years and whose child was admitted to the PICU for more than 24 hours to up to 1 week. INTERVENTION: Semi-structured one-on-one interviews. RESULTS: Forty of 70 parents (57%) interviewed said they could imagine a situation in which they would consider withdrawing life-sustaining therapies. When asked if specific factors might influence their decision making, 64% of parents said they would consider withdrawing life-sustaining therapies if their child were suffering; 51% would make such a decision based on quality-of-life considerations; 43% acknowledged the influence of physician-estimated prognosis in their decision; and 7% said financial burden would affect their consideration. Qualitative analysis of their subsequent comments identified 9 factors influential to parents when considering withdrawing life-sustaining therapies: quality of life, suffering, ineffective treatments, faith, time, financial considerations, general rejection of withdrawing life-sustaining therapies, mistrust/doubt toward physicians, and reliance on self/intuition. CONCLUSION: Parents describe a broad range of views regarding possible consideration of withdrawing life-sustaining therapies for their children and what factors might influence such a decision.

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