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[The pediatric patient at the end-of-life. A challenge for its identification and treatment. A survey in pediatricians and medical residents]

Journal title
Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion
Publication year
2011
Author(s)
Rendon-Macias, M. E.; Olvera-Gonzalez, H.; Villasis-Keever, M. A.
Pages
135-47
Volume
63
Number
2

BACKGROUND: Identification of pediatric patients at the end-of-life is not easy because criteria used are based on adults’ criteria. OBJECTIVES: In this survey we explore the children end-of-life definition pediatricians have, as well as to determine which interventions they use when caring a patient at end-of-life. MATERIAL AND METHODS: Setting: Tertiary referral pediatric hospital. Participants: Staff pediatricians (SP) and medical residents (MR). Methods: A self-administrated questionnaire was built and validated. It contains five vignettes of pediatric patients: Two with WHO criteria for an end-of-life condition (EC) and three without an end-of-life condition (NEC). Participants identified each patient with or without an end-of-life condition, and which palliative actions they would perform accordingly Their responses were recorded in a 4-option Likert scale. Ordinal regression was used to assess if some of the participants’ characteristics were related to the identification of an end-of-life condition. RESULTS: Response rate was 84.2% (128/152); of whom 63 were SP and 65 MR. EC cases were well identified in 90 and 93%, while NEC in 30 and 40%, respectively Palliative actions were more according in EC patients, but around 20% would not provide them. Among NEC patients, there were more disparities of palliative actions to be delivered, and it was statistically significantly. Ordinal regression showed that some participants’ characteristics are associated to the appropriate identification of end-of-life patients; however, these factors were not consistent across the five scenarios. CONCLUSIONS: Among pediatricians, criteria of end-of-life conditions are not well established, neither the palliative actions. Educational interventions are needed to improve the quality of life of these children.

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