Parallel planning and the paediatric critical care patient

Area of Science:

• Pediatric Critical Care
• Palliative Care
• Bioethics

Background:

• Increasing numbers of children with life-limiting conditions (LLCs) are admitted to pediatric critical care (PCC) units.
• These children face high risks of complications and mortality during prolonged PCC admissions.
• Pre-admission discussions about end-of-life care wishes are infrequent for children with LLCs and their families.

Purpose of the Study:

• To explore parental decision-making processes for children with LLCs during critical illness.
• To examine the role of parallel planning and advance care plans in pediatric critical care settings.
• To understand the complexities surrounding end-of-life care decisions for critically ill children with LLCs.

Main Methods:

• Systematic literature review of studies on decision-making in pediatric critical care for children with LLCs.
• Analysis of factors influencing parental choices during critical illness.
• Examination of the integration and impact of advance care planning strategies.

Main Results:

• Parental decisions are influenced by a complex interplay of medical information, emotional factors, and perceived child well-being.
• Advance care plans and parallel planning can support informed decision-making but require sensitive implementation.
• Gaps exist in communication and documentation of patient and family wishes prior to PCC admission.

Conclusions:

• Improved understanding of parental decision-making is essential for providing ethical and compassionate care to children with LLCs in PCC.
• Facilitating advance care planning and parallel planning can empower families and align care with patient and family values.
• Further research is needed to develop and evaluate effective strategies for supporting families through critical illness and end-of-life care decisions.