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. 2021 Mar;35(3):503-528.
doi: 10.1177/0269216320983197. Epub 2020 Dec 29.

Factors associated with health professionals decision to initiate paediatric advance care planning: A systematic integrative review

Karen Carr  1 , Felicity Hasson  1 , Sonja McIlfatrick  1 , Julia Downing  2
Affiliations

Factors associated with health professionals decision to initiate paediatric advance care planning: A systematic integrative review

Karen Carr et al. Palliat Med. 2021 Mar.

Abstract

Background: Advance care planning for children with palliative care needs is an emotionally, legally and complex aspect of care, advocated as beneficial to children, families and health professionals. Evidence suggests healthcare professionals often avoid or delay initiation. An overview of evidence on the factors that influence and impact on the health care professional's initiation of paediatric advance care planning process is lacking.

Aim: To review and synthesise evidence on the factors associated with health care professional's decision to initiate paediatric advance care planning.

Design: Systematic integrative review using constant comparison method.

Data sources: Electronic databases (CINAHL, PubMed, PsycINFO, Ovid MEDLINE, EMBASE, Web of Science and Cochrane) using MeSH terms and word searches in Oct 2019. No limit set on year of publication or country. Grey literature searches were also completed.

Results: The search yielded 4153 citations from which 90 full text articles were reviewed. Twenty-one met inclusion criteria consisting of quantitative (n = 8), qualitative (n = 6) and theoretical (n = 7) studies.Findings revealed overarching and interrelated themes 'The timing of initiation', 'What makes an initiator, 'Professionals' perceptions' and 'Prerequisites to initiation'.

Conclusions: This review provides insights into the complexities and factors surrounding the initiation of advance care planning in paediatric practice. Uncertainty regarding prognosis, responsibility and unpredictable parental reactions result in inconsistent practice. Future research is required to inform intervention to assist health care professionals when initiating paediatric advance care planning conversations.

Keywords: Child; adolescent; advance care planning; decision making; infant; paediatric; palliative care; terminal care.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA Initiation of paediatric advance care planning integrative literature review. PLoS Medicine (OPEN ACCESS) Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097.
See this image and copyright information in PMC

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