Publication
Pediatric intensivist end-of-life practices and attitudes in Vietnam
Schiltz B, Liu J, Fadadu P, Kumbamu A, Phan P, Tran X, Ouellette Y · Critical Care Medicine · 2018
Learning Objectives: Although there has been a significant reduction in childhood mortality, Vietnam's under-five and neonatal mortality rate still stand at 22 and 11 per 1,000 live births, respectively. Few studies exist on physician attitudes towards life-sustaining treatment and decision-making in the Vietnamese pediatric intensive care unit. This study aims at understanding pediatric intensivist perceptions, attitudes and practices surrounding the end of life in a tertiary care pediatric hospital in Vietnam. Methods: A mixed-method study utilizing paper survey and semistructured interviews were conducted at a tertiary care pediatric hospital in Vietnam. NICU and PICU physicians and nurses were included. A total of 18 interviews and 68 surveys were completed and subsequently analyzed. Results: Qualitative analysis demonstrates three major themes surrounding end of life care: socioeconomic and religious/cultural factors influence decision to withdraw treatment or not; lack of physician experience and infrastructure influence physician decisions, and who initiates (parent vs. physician) discussion about treatment decisions influences dynamics of the end of life processes. Quantitative analysis demonstrates that intensivists largely agree on involving parents in decisions to withdraw or not escalate life sustaining treatment, but not as readily with alternative resuscitation status. Intensivists find it important to try all potentially lifesaving interventions, however, the presence of a chronic medical condition may influence that decision. Most intensivists regard it as a personal disappointment if the patient dies. Conclusions: Many opportunities for improvement are present for pediatric end of life care in Vietnam. Infrastructure and education regarding palliation in the ICU setting may be of benefit. In addition, psychosocial factors that are unique to the Vietnamese population are worth exploring as they intersect with the evolving modern medical technologies and chronically ill children.
Synced from the TRENDS in Pediatric Palliative Care Zotero library, curated by The Siden Research Team. ICPCN does not host or verify the full text.