ArticleBMJ open2022
Conceptualising paediatric advance care planning: a qualitative phenomenological study of paediatricians caring for children with life-limiting conditions in Australia.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Pediatric advance care planning: a mixed-methods evaluation of documentation and sharing in current practice.BMC palliative care · 2026Article
- Advance care planning for children with life-limiting and life-threatening conditions.The Cochrane database of systematic reviews · 2025Article
- Les objectifs des échanges sur les soins et de la planification préalable des soins chez les patients d'âge pédiatrique atteints d'une maladie grave.Paediatrics & child health · 2024Review
- Goals of care conversations and advance care planning for paediatric patients living with serious illness.Paediatrics & child health · 2024Review
- Implementing advance care planning in palliative and end of life care: a scoping review of community nursing perspectives.BMC geriatrics · 2024Article
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesAdvance care planning (ACP) helps families and paediatricians prepare and plan for end-of-life decision-making. However, there remains inconsistency in its practice with the limited literature describing what this preparation involves, and whether paediatricians recognise a difference between the process of ACP and its outcomes, such as resuscitation plans. This study aims to understand how paediatricians conceptualise ACP when caring for children with life-limiting conditions (LLC) who are unable to participate in decision-making for his/herself.
designIndividual, semistructured, vignette-based qualitative interviews.
settingAcute inpatient and long-term outpatient paediatric care in three secondary and two tertiary centres in Victoria, Australia.
participants25 purposively sampled paediatricians who treat children with LLC, outside the neonatal period. Paediatricians were excluded if they worked within specialist palliative care teams or assisted in this study's design.
resultsFour key themes were identified when approaching end-of-life decision-making discussions: (1) there is a process over time, (2) there are three elements, (3) the role of exploring parental values and (4) the emotional impact. The three elements of this process are: (1) communicating the child's risk of death, (2) moving from theoretical concepts to practice and (3) documenting decisions about resuscitation or intensive technologies. However, not all paediatricians recognised all elements as ACP, nor are all elements consistently or intentionally used. Some paediatricians considered ACP to be only documentation of decisions in advance.
conclusionThere is a preparatory process of discussions for end-of-life decision-making, with elements in this preparation practised within therapeutic relationships. Complexity in what constitutes ACP needs to be captured in guidance and training to include intentional exploration of parental values, and recognition and management of the emotional impact of ACP could increase its consistency and value.
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