Navigating the shadows: medical professionals’ values and perspectives on end-of-life care within pediatric intensive care units in Croatia

Scientific paper - Original scientific paper

• Author: Marko Ćurković
• Author: Filip Rubić
• Author: Ana Jozepović
• Author: Milivoj Novak
• Author: Boris Filipović-Grčić
• Author: Julije Meštrović
• Author: Kristina Lah Tomulić
• Author: Branimir Peter
• Author: Diana Špoljar
• Author: Štefan Grosek
• Author: Sunčana Janković
• Author: Jurica Vuković
• Author: Mirjana Kujundžić Tiljak
• Author: Andrija Štajduhar
• Author: Ana Borovečki
• Author's institution: University of Zagreb; School of Medicine; (Department of Medical Statistics, Epidemiology and Medical Informatics)
• Author's institution: University of Zagreb; School of Medicine; (Department of Pediatrics)
• Author's institution: University of Zagreb; School of Medicine; (Department of Social Medicine and Health Care Organization)
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Public Health and Health Care; Social Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Public Health and Health Care; Epidemiology

Abstract (english)

Background and aim: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

• Keywords (english): end-of-life; ethics; healthcare professionals; intensive care; intensive care units; pediatrics; withdrawing; withholding
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Frontiers in Pediatrics
• Numbering: vol. 12, 1394071
• e-ISSN: 2296-2360
• DOI: https://doi.org/10.3389/fped.2024.1394071
• URN:NBN: urn:nbn:hr:105:862493
• Publication: 2024-08-12
• Document URL: https://www.frontiersin.org/articles/10.3389/fped.2024.1394071/full
• Type of resource: Text
• Access conditions: Open access
• Created on: 2025-03-26 15:06:37