International pediatric palliative sedation practice and physician opinions

10-2022 to 3-2025

Background
Deciding on futility of curative treatment in favor of a full focus on comfort care in pediatrics brings forth challenging ethical and clinical-pharmacological discussions. Among other medical decisions at the end of life, palliative sedation could be considered. The term “palliative sedation” is used to describe the specific practice of reducing consciousness by administering sedatives to treat pain and refractory symptoms at the end of life. An international guideline on the use of palliative sedation is lacking. The majority of available literature concerns single- center retrospective studies, used to develop different guidelines in several countries. Decision of depth of sedation, type and amount of medication, starting at what symptoms and from what point in the palliative course, is complex. Infant mortality is low and paediatricians, especially in regional centers, do not often encounter palliative sedation. Thus, only few pediatricians are able to build enough clinical experience to confidently provide such care, and are able to rely on previous experience to develop their own best practice customs.

Aims
We aim to
1) explore attitudes and practices regarding pediatric palliative sedation of pediatricians responsible for caring for terminally ill pediatric patients between 0 and 15 years old,
2) investigate the conditions in which pediatricians would start up palliative sedation based on three vignette cases, including a thorough comparison between the intention of pediatricians to start up sedation in the three vignette cases, and
3) examining international differences between attitudes, practices and intentions to start pediatric palliative sedation.

Methods
We will perform a mail survey to gain insight into medical practices and opinions of Belgian pediatricians regarding pediatric palliative sedation in the last days of life. The questionnaire and study design will then be translated and adapted to other European countries (the UK, Portugal, the Netherlands, Norway, Italy, the Czech Republic and Switzerland).