PDF(Pubmed)
Abstract：
Most deaths in Pediatric Intensive Care Units involve forgoing life-sustaining treatment. Such deaths required carefully planned end-of-life care built on compassion and focused on palliative care measures. This study aims to assess topics related to the end of life care in Brazilian pediatric intensive care units from the perspective of a multidisciplinary team.
The authors used a tested questionnaire, utilizing Likert-style and open-ended questions. After ethics committee approval, it was sent by email from September to November/2019 to three Pediatric Intensive Care Units in the South and Southeast of Brazil. One unit was exclusively dedicated to oncology patients; the others were mixed units.
From 144 surveys collected (23% response rate) 136 were analyzed, with 35% physicians, 30% nurses, 21% nurse technicians, and 14% physiotherapists responding. Overall, only 12% reported enough end-of-life care training and 40% reported never having had any, albeit this was not associated with the physician\'s confidence in forgoing life-sustaining treatment. Furthermore, 60% of physicians and 46% of other professionals were more comfortable with non-escalation than withdrawing therapies, even if this could prolong suffering. All physicians were uncomfortable with palliative extubation; 15% of all professionals have witnessed it. The oncologic team uniquely felt that \"resistance from the teams of specialists\" was the main barrier to end-of-life care implementation.
Most professionals felt unprepared to forego life-sustaining treatment. Even for terminally ill patients, withholding is preferred over the withdrawal of treatment. Socio-cultural barriers and the lack of adequate training may be contributing to insecurity in the care of terminally ill patients, diverging from practices in other countries.
The authors used a tested questionnaire, utilizing Likert-style and open-ended questions. After ethics committee approval, it was sent by email from September to November/2019 to three Pediatric Intensive Care Units in the South and Southeast of Brazil. One unit was exclusively dedicated to oncology patients; the others were mixed units.
From 144 surveys collected (23% response rate) 136 were analyzed, with 35% physicians, 30% nurses, 21% nurse technicians, and 14% physiotherapists responding. Overall, only 12% reported enough end-of-life care training and 40% reported never having had any, albeit this was not associated with the physician\'s confidence in forgoing life-sustaining treatment. Furthermore, 60% of physicians and 46% of other professionals were more comfortable with non-escalation than withdrawing therapies, even if this could prolong suffering. All physicians were uncomfortable with palliative extubation; 15% of all professionals have witnessed it. The oncologic team uniquely felt that \"resistance from the teams of specialists\" was the main barrier to end-of-life care implementation.
Most professionals felt unprepared to forego life-sustaining treatment. Even for terminally ill patients, withholding is preferred over the withdrawal of treatment. Socio-cultural barriers and the lack of adequate training may be contributing to insecurity in the care of terminally ill patients, diverging from practices in other countries.
摘要：
目的：儿科重症监护病房的大多数死亡涉及放弃维持生命的治疗。这种死亡需要精心策划的基于同情心的临终关怀，并侧重于姑息治疗措施。本研究旨在从多学科团队的角度评估与巴西儿科重症监护病房临终关怀相关的主题。
方法：作者使用了一份测试问卷，利用李克特风格和开放式问题。伦理委员会批准后,它于2019年9月至11月通过电子邮件发送至巴西南部和东南部的3个儿科重症监护病房.一个单位专门用于肿瘤患者；其他是混合单位。
结果：从收集的144个调查（23％的响应率）中分析了136个，35%的医生，30%的护士21%的护士技师,14%的物理治疗师做出了回应。总的来说,只有12%的人报告说有足够的临终关怀培训，40%的人报告从未接受过任何培训，尽管这与医生放弃维持生命治疗的信心无关。此外，60％的医生和46％的其他专业人员对不升级比退出疗法更满意。即使这可以延长痛苦。所有医生都对姑息性拔管感到不舒服；所有专业人员中有15％目睹了这种情况。肿瘤学团队独特地认为，“来自专家团队的抵制”是临终护理实施的主要障碍。
结论：大多数专业人员认为不准备放弃维持生命的治疗。即使是绝症患者，扣留优先于停药。社会文化障碍和缺乏足够的培训可能会导致对绝症患者的护理不安全，与其他国家的做法不同。
方法：作者使用了一份测试问卷，利用李克特风格和开放式问题。伦理委员会批准后,它于2019年9月至11月通过电子邮件发送至巴西南部和东南部的3个儿科重症监护病房.一个单位专门用于肿瘤患者；其他是混合单位。
结果：从收集的144个调查（23％的响应率）中分析了136个，35%的医生，30%的护士21%的护士技师,14%的物理治疗师做出了回应。总的来说,只有12%的人报告说有足够的临终关怀培训，40%的人报告从未接受过任何培训，尽管这与医生放弃维持生命治疗的信心无关。此外，60％的医生和46％的其他专业人员对不升级比退出疗法更满意。即使这可以延长痛苦。所有医生都对姑息性拔管感到不舒服；所有专业人员中有15％目睹了这种情况。肿瘤学团队独特地认为，“来自专家团队的抵制”是临终护理实施的主要障碍。
结论：大多数专业人员认为不准备放弃维持生命的治疗。即使是绝症患者，扣留优先于停药。社会文化障碍和缺乏足够的培训可能会导致对绝症患者的护理不安全，与其他国家的做法不同。
