Withdrawing treatment for children and young people: Decision-making experiences of health professionals

Abdin, Shanara

Abstract

Background: The decision to withdraw or withhold treatment from children can be a complex and emotional decision-making process for everyone who is involved. With the complexity of decision-making in paediatric medicine ever increasing due to an increased number of cases, there is a growing need to understand how treatment decisions are made, the impact this has on those making the decisions and how professionals can be supported throughout the decision-making process.
Objectives: The aim of this qualitative study was to explore the decision-making experiences of professionals working in healthcare during withdrawing treatment from children. The study examined factors that influence professionals in deciding whether to withdraw a child from treatment and how decision-making is managed amongst professionals as an individual and as a team.
Method: A purposive sample of health professionals (HCPs) working at a Children’s Hospital in the UK, with children with life-limiting illnesses where treatment has been withdrawn, were invited to participate. All participants were given the option to partake in the research in several ways to maximise their potential to participate. This included digitally-recorded face-to-face semi-structured interviews, skype or telephone interviews. Data was transcribed verbatim, anonymised, and analysed using a thematic framework method.
Results: A total of fifteen participants were interviewed. The interview transcripts produced rich data which highlighted how HCPs decide on withdrawing treatment for a child. The thematic analysis process that was applied to the transcripts elicited key concepts. Five interrelated themes with associated subthemes were generated to help understand the experiences of health professionals in decision-making on withdrawing a child’s treatment: 1) Best Interests of the Child (2) Multidisciplinary Approach (3) External Factors (4) Psychological Wellbeing (5) Recommendations to support decision-making. Although those five themes emerged, the most prominent one was that all decisions were based on the best interests of a child. This led to professionals considering several factors such as exploring all treatment options, the severity of the condition and the competency of the child to decide. Further to this, professionals felt that the child’s family played a huge role amongst the decision-making process with communication and cultural factors such as health professionals ‘playing god’ being reported as key influencers.
Conclusion: The decision-making process was identified as being predominately medically led with medical professionals making the decision. A shared decision-making approach could support professionals, children, and their families if decisions are made collectively. Future research should investigate the views from parents and families on withdrawing treatment and how this influences the decision-making process. To strengthen further studies within this area, a greater number of male health professionals should be included to offer further robust views from the perspectives of diverse health professionals.

• Thesis Type: Thesis
• Deposit Date: May 22, 2020
• Publicly Available Date: Dec 18, 2020
• Public URL: https://uwe-repository.worktribe.com/output/5994780
• Award Date: Dec 18, 2020