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May 14, 2019

16th World Congress of the European Association for Palliative Care

Modifiable Factors for Improving End-of-Life Decision-Making for Neonatologists, Nurses, and Parents in the Neonatal Intensive Care Unit: A Qualitative Study






Modifiable factors for improving end-of-life decision-making for neonatologists, nurses, and parents in the Neonatal Intensive Care Unit (NICU). Background/aims: Neonatal end-of-life decision-making processes present ethically difficult and stressful dilemmas for medical staff as well as for parents. To improve support in future cases, it is necessary to know what factors complicated or facilitated neonatal end-of-life decision-making for the main actors. This study therefore aimed to identify barriers and facilitators in neonatal end-of-life decision-making as perceived by neonatologists, nurses, and parents. Methods: We conducted semi-structured face-to-face interviews with 15 neonatologists and 15 neonatal nurses, recruited via five NICU's in Flanders, Belgium. Both groups were asked what factors facilitated and what factors complicated neonatal decision-making. Two researchers independently analyzed the full sample, using content analysis to extract and summarize barriers and facilitators. Results/discussion: Modifiable barriers and facilitators emerged at three levels. First, context: This includes the child's, parents', and physicians' characteristics, therapeutic bond between medical staff and parents, medical options. Second, process: This includes having regular communication and multidisciplinary meetings, different opinions, inclusion in the process, and advance care planning. Third, structure: This includes emotional and/or practical support, the legal framework, and NICU policy and expertise. The barriers and facilitators can ultimately help to improve support in future neonatal decision-making. Funded by Research Foundation Flanders.

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© Copyright 2019 Morressier GmbH. All rights reserved.

© Copyright 2019 Morressier GmbH.
All rights reserved.