Differences in perspectives of pediatricians on advance care planning: a cross-sectional survey
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RESEARCH ARTICLE
Open Access
Differences in perspectives of pediatricians on advance care planning: a cross-sectional survey In Gyu Song1†, Sung Han Kang2†, Min Sun Kim3* , Cho Hee Kim4, Yi Ji Moon5 and Jung Lee5
Abstract Background: The increase in the number of pediatric patients with complex health conditions necessitates the application of advance care planning for children. Earlier, withdrawal of life-sustaining treatment was taboo in the medical society in South Korea due to the history of such practice being punishable by law, and physicians tended to pursue aggressive treatment. With changes in public opinion on end-of-life care, the Korean government enacted a new law that protect human dignity by respecting patients’ self-determination and facilitating advance care planning. However, little is known about current state of advance care planning for pediatric patients. The study aimed to assess perceptions regarding advance care planning among South Korean pediatricians and clarify any differences in perception among pediatric subspecialties. Methods: This study was an observational cross-sectional survey that used a web-based self-report questionnaire. Participants comprised of pediatricians currently caring for children with life-limiting conditions in 2018. Results: Of the 96 respondents, 89 were included in the analysis. In a hypothetical patient scenario, more hematooncologists and intensivists than neonatologists and neurologists preferred to provide comfort care than aggressive treatment. While 72.2% of hemato-oncologists reported that they usually or always discuss advance care plans with parents during treatment, more than half of other pediatricians reported that they seldom do so. Furthermore, 65% of respondents said that they never discuss advance care planning with adolescent patients. Moreover, there were no notable differences among subspecialties. The most prevalent answers to factors impeding advance care planning were lack of systemic support after performing advance care planning (82.0%) and uncertain legal responsibilities (70.8%). Conclusions: The pediatricians differed in their experiences and attitudes toward advance care planning based on their subspecialty. Consequently, institutional support and education should be provided to physicians so that they can include children and families in discussions on prognosis. Keywords: Advance care planning, Pediatrician, Palliative care, Prognosis
* Correspondence: [email protected] † In Gyu Song and Sung Han Kang contributed equally to this work. 3 Department of Pediatrics, Seoul National University Children’s Hospital, 101, Daehak-ro, Jungno-gu, Seoul 03080, South Korea Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provi
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