title: Parental views on withdrawing life-sustaining therapies in critically ill children.
abstract: OBJECTIVE
  To broaden existing knowledge of pediatric end-of-life decision making by exploring factors described by parents of patients in the pediatric intensive care unit (PICU) as important/influential if they were to consider withdrawing life-sustaining therapies.
  
  
  METHODS
  Quantitative and qualitative analysis of semi-structured one-on-one interviews.
  
  
  METHODS
  The PICUs at 2 tertiary care hospitals.
  
  
  METHODS
  English- or Spanish-speaking parents who were older than 17 years and whose child was admitted to the PICU for more than 24 hours to up to 1 week.
  
  
  METHODS
  Semi-structured one-on-one interviews.
  
  
  RESULTS
  Forty of 70 parents (57%) interviewed said they could imagine a situation in which they would consider withdrawing life-sustaining therapies. When asked if specific factors might influence their decision making, 64% of parents said they would consider withdrawing life-sustaining therapies if their child were suffering; 51% would make such a decision based on quality-of-life considerations; 43% acknowledged the influence of physician-estimated prognosis in their decision; and 7% said financial burden would affect their consideration. Qualitative analysis of their subsequent comments identified 9 factors influential to parents when considering withdrawing life-sustaining therapies: quality of life, suffering, ineffective treatments, faith, time, financial considerations, general rejection of withdrawing life-sustaining therapies, mistrust/doubt toward physicians, and reliance on self/intuition.
  
  
  CONCLUSIONS
  Parents describe a broad range of views regarding possible consideration of withdrawing life-sustaining therapies for their children and what factors might influence such a decision.
authors.affiliation: Buehler Center on Aging, Health & Society, Children's Memorial Hospital, Division of Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60614, USA. kmichelson@childrensmemorial.org
authors.forename: Kelly Nicole
authors.initials: KN
authors.lastname: Michelson
authors.forename: Tracy
authors.initials: T
authors.lastname: Koogler
authors.forename: Christine
authors.initials: C
authors.lastname: Sullivan
authors.forename: María del Pilar
authors.initials: Mdel P
authors.lastname: Ortega
authors.forename: Emily
authors.initials: E
authors.lastname: Hall
authors.forename: Joel
authors.initials: J
authors.lastname: Frader
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D003657:Decision Making; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007407:Interviews as Topic; D019545:Intuition; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control / Q000523:psychology; D010290:Parents / Q000523:psychology*; D011368:Professional-Family Relations; D011788:Quality of Life; D012067:Religion; D013995:Time; D017211:Treatment Failure; D035502:Trust; D028761:Withholding Treatment; D055815:Young Adult