Neonatal palliative care: developing consensus among neonatologists using the Delphi technique in Portugal

Area of Science:

• Neonatal Medicine
• Palliative Care
• Medical Ethics

Background:

• Pediatric palliative care in Portugal shows progress, yet requires further development in programs and guidelines.
• Physicians are key decision-makers for transitioning neonates to palliative care within neonatal intensive care units.
• Raising awareness and motivation among neonatologists regarding neonatal palliative care is crucial.

Framework:

• The study adapted Catlin and Carter's 2002 protocol to assess neonatologists' willingness to create a national palliative care and end-of-life protocol.
• A 3-round Delphi technique survey was employed to gather expert consensus.

Implementation:

• An expert panel of 57 Portuguese neonatologists (41% of the total) participated.
• The survey was conducted online via a private website, with data collection and feedback managed through email.

Implications:

• Consensus was reached on seven critical areas: planning, prenatal palliative care, neonatal care criteria, parental involvement, physician needs, pain/symptom management, and end-of-life decisions (including ventilation and nutrition/hydration withdrawal).
• This agreement provides a foundation for a unified, nationwide approach to neonatal palliative and end-of-life care in Portugal.