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Implementing a Best Practice Guideline for Withdrawing Life Sustaining Therapies at a Large Pediatric Hospital

David Mauser1, Maeve Bartiss2, Josh Lipsitz3

  • 1Stanford University (D.M.), Division of Quality of Life and Pediatric Palliative Care, Palo Alto, CA.

Journal of Pain and Symptom Management
|December 24, 2025
PubMed

Insights

Developing a best practice guideline (BPG) for Withdrawal of Life Sustaining Therapies (WOLST) in pediatrics is feasible and helpful. Improved dissemination of the BPG and note template is needed for wider adoption.

Area of Science:

  • Pediatric critical care medicine
  • Clinical practice guideline development
  • End-of-life care research

Background:

  • Withdrawal of Life Sustaining Therapies (WOLST) is a critical procedure in pediatric inpatient deaths.
  • No established best practice guideline (BPG) currently exists for pediatric WOLST.
  • This study aimed to develop and implement a BPG and standard note template for WOLST.

Purpose of the Study:

  • To develop and implement a best practice guideline (BPG) for pediatric Withdrawal of Life Sustaining Therapies (WOLST).
  • To create and implement a standard note template to support WOLST procedures.
  • To evaluate the feasibility and helpfulness of the developed BPG and template.

Main Methods:

  • Utilized Plan-Do-Study-Act (PDSA) cycles for tool development and implementation.
  • Engaged stakeholders, distributed the BPG, and conducted presentations in intensive care units.
  • Measured tool usage (process), perceived usefulness (outcome), and unintended consequences.

Main Results:

  • 100% of users found the note template helpful; 95% found the BPG helpful.
  • Despite helpfulness, 65% were unaware of the note template and 78% unaware of the BPG.
  • The study aimed for a 20% increase in tool use within 6 months.

Conclusions:

  • Implementation of a BPG for pediatric WOLST is feasible and beneficial.
  • The developed tools (BPG and note template) are perceived as helpful by users.
  • Improved dissemination strategies are necessary for broader adoption and impact.
Abstract

Keywords:
Quality improvementbest practice guidelineend of lifepediatricsstandardizationwithdrawal of life-sustaining therapies

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