Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2022
Bereaved Caregiver Perspectives on the End of Life in Pediatric Patients With Ventricular Assist Devices.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Bui Christine M, Schneider Lauren M, Brown Michelle R, Char Danton S, McIlvennan Colleen K, Hollander Seth A
Аннотация
OBJECTIVES: Ventricular assist devices (VADs) are increasingly used in pediatric heart failure as bridges to heart transplantation, although 25% will die with VADs. Family experiences in this population are not well-described. The objective is to understand bereaved families' perspectives on VAD and end-of-life decision-making.
DESIGN: Semistructured interviews with bereaved caregivers of pediatric VAD patients.
SETTING: Tertiary children's hospital.
PATIENTS: Families of six pediatric VAD patients who died from 2014 to 2020.
INTERVENTIONS: Not available.
MEASUREMENTS AND MAIN RESULTS: Applying a grounded theory framework, interviews were coded by two independent readers using qualitative software. Themes were discussed in iterative multidisciplinary meetings. Participants were interviewed at a median 2.4 years after their child died. Three major themes emerged: 1) "lack of regret" for VAD implantation despite the outcome; 2) "caregiver-child accord" (via patient's verbal assent or physical cues) at implantation and end-of-life was important in family decision-making; and 3) development of a "local surrogate family" (medical team and peer families) provided powerful support.
CONCLUSIONS: Bereaved families' perspectives provide insight into quality decision-making for major interventions and end-of-life care in pediatric patients with chronic illness who face decisions regarding technology dependence.
DESIGN: Semistructured interviews with bereaved caregivers of pediatric VAD patients.
SETTING: Tertiary children's hospital.
PATIENTS: Families of six pediatric VAD patients who died from 2014 to 2020.
INTERVENTIONS: Not available.
MEASUREMENTS AND MAIN RESULTS: Applying a grounded theory framework, interviews were coded by two independent readers using qualitative software. Themes were discussed in iterative multidisciplinary meetings. Participants were interviewed at a median 2.4 years after their child died. Three major themes emerged: 1) "lack of regret" for VAD implantation despite the outcome; 2) "caregiver-child accord" (via patient's verbal assent or physical cues) at implantation and end-of-life was important in family decision-making; and 3) development of a "local surrogate family" (medical team and peer families) provided powerful support.
CONCLUSIONS: Bereaved families' perspectives provide insight into quality decision-making for major interventions and end-of-life care in pediatric patients with chronic illness who face decisions regarding technology dependence.