Publication
"It's the fear of the unknown" clinicians' perceptions on paediatric compassionate transport to preferred place of death: A qualitative descriptive study
Rowe J, Hawley M, Bloomer M, O'Neill J · Australian Critical Care · 2026
Background Compassionate transport is used to transfer dying neonates and children from hospital wards to their preferred place for death, such as home. For families, choice of where their child will die is important and meaningful. Yet the child’s physiological instability, care complexity, and the lack of comprehensive guidelines impede wider use of compassionate transport. Objectives The aim of this study was to identify clinicians’ perceptions of enablers and barriers to transferring children receiving life-sustaining therapies from the paediatric or neonatal intensive care unit to their preferred place of death. Methods A qualitative, descriptive study was conducted. Focus groups were conducted with neonatal and paediatric clinicians with critical care, palliative care, hospice, and compassionate transport experience from two paediatric care facilities in Victoria, Australia. Focus groups were audio recorded, transcribed, and analysed using inductive content analysis. Findings Forty-three clinicians participated across nine focus groups, conducted between February and March 2025. Four main categories were identified: (i) Unfamiliar and nascent practice, despite a general willingness to support the program, limited experience creates psychological barriers to engagement; (ii) Putting the child and family first, which explores the importance of prioritising the values and preferences of children and their families, rather than relying solely on clinicians’ assumptions about optimal end-of-life care; (iii) Practical considerations, encompasses challenges related to interdisciplinary coordination and communication, planning for preferred care locations, and managing time constraints; and (iv) The rightness of compassionate transport, such as concerns regarding financial and resource limitations as well as the moral weight and complexity inherent in providing end-of-life care. Conclusions Compassionate transport is generally supported by clinicians as a meaningful end-of-life care option for critically ill neonates and children, despite practical, organisational, and ethical challenges to its implementation. Expanding existing guidance to address the specific needs of neonatal and paediatric intensive care settings, alongside multidisciplinary education, collaboration, and staff support, may increase clinician confidence and facilitate equitable, family-centred implementation of compassionate transport.
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