Abstract
BackgroundThe increase in the number of pediatric patients with complex health conditions necessitates the application of advance care planning for children. Earlier, withdrawal of life-sustaining treatment was taboo in the medical society in South Korea due to the history of such practice being punishable by law, and physicians tended to pursue aggressive treatment. With changes in public opinion on end-of-life care, the Korean government enacted a new law that protect human dignity by respecting patients’ self-determination and facilitating advance care planning. However, little is known about current state of advance care planning for pediatric patients. The study aimed to assess perceptions regarding advance care planning among South Korean pediatricians and clarify any differences in perception among pediatric subspecialties.MethodsThis study was an observational cross-sectional survey that used a web-based self-report questionnaire. Participants comprised of pediatricians currently caring for children with life-limiting conditions in 2018.ResultsOf the 96 respondents, 89 were included in the analysis. In a hypothetical patient scenario, more hemato-oncologists and intensivists than neonatologists and neurologists preferred to provide comfort care than aggressive treatment. While 72.2% of hemato-oncologists reported that they usually or always discuss advance care plans with parents during treatment, more than half of other pediatricians reported that they seldom do so. Furthermore, 65% of respondents said that they never discuss advance care planning with adolescent patients. Moreover, there were no notable differences among subspecialties. The most prevalent answers to factors impeding advance care planning were lack of systemic support after performing advance care planning (82.0%) and uncertain legal responsibilities (70.8%).ConclusionsThe pediatricians differed in their experiences and attitudes toward advance care planning based on their subspecialty. Consequently, institutional support and education should be provided to physicians so that they can include children and families in discussions on prognosis.
Highlights
The increase in the number of pediatric patients with complex health conditions necessitates the application of advance care planning for children
The instrument comprised five major domains: 1) Demographic questions, background subspecialty, and career as a pediatrician; 2) preference in decision-making and timing of discussions on providing life-sustaining treatment in two scenarios; 3) six items pertaining to pediatricians’ experiences in making decisions regarding life-sustaining treatment; 4) two items related to the barriers to Advance care planning (ACP) implementation in children and adolescents and its weights; and 5) three items on attitudes toward legal issues (Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End-oflife)
We found that preferred treatments for respiratory difficulties or timing for providing ACP of patients with life-limiting conditions were different for different subspecialties
Summary
The increase in the number of pediatric patients with complex health conditions necessitates the application of advance care planning for children. Advance care planning (ACP) is defined as the process that “enables individuals to define goals and preferences for future medical treatment and care, to discuss these goals and preferences with family and healthcare providers, and to record and review these preferences if appropriate” [1]. Various life-limiting pediatric conditions warrant ACP application, such as cancer, extreme prematurity, congenital anomalies, and neuromuscular diseases, several factors cause clinicians to avoid communicating with pediatric patients and families about ACP. These barriers exist for both healthcare professionals and patients’ parents. The people of South Korea are generally reluctant to disclose disease details to pediatric patients due to their concern that such disclosure may exacerbate illness and impact survival by causing emotional distress [9, 10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
