title: [The pediatric patient at the end-of-life. A challenge for its identification and treatment. A survey in pediatricians and medical residents].
abstract: BACKGROUND
  Identification of pediatric patients at the end-of-life is not easy because criteria used are based on adults' criteria.
  
  
  OBJECTIVE
  In this survey we explore the children end-of-life definition pediatricians have, as well as to determine which interventions they use when caring a patient at end-of-life.
  
  
  METHODS
  
  
  
  METHODS
  Tertiary referral pediatric hospital.
  
  
  METHODS
  Staff pediatricians (SP) and medical residents (MR).
  
  
  METHODS
  A self-administrated questionnaire was built and validated. It contains five vignettes of pediatric patients: Two with WHO criteria for an end-of-life condition (EC) and three without an end-of-life condition (NEC). PARTICIPANTS identified each patient with or without an end-of-life condition, and which palliative actions they would perform accordingly Their responses were recorded in a 4-option Likert scale. Ordinal regression was used to assess if some of the participants' characteristics were related to the identification of an end-of-life condition.
  
  
  RESULTS
  Response rate was 84.2% (128/152); of whom 63 were SP and 65 MR. EC cases were well identified in 90 and 93%, while NEC in 30 and 40%, respectively Palliative actions were more according in EC patients, but around 20% would not provide them. Among NEC patients, there were more disparities of palliative actions to be delivered, and it was statistically significantly. Ordinal regression showed that some participants' characteristics are associated to the appropriate identification of end-of-life patients; however, these factors were not consistent across the five scenarios.
  
  
  CONCLUSIONS
  Among pediatricians, criteria of end-of-life conditions are not well established, neither the palliative actions. Educational interventions are needed to improve the quality of life of these children.
authors: Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social.
authors: Mario Enrique
authors: ME
authors: Rendón-Macías
authors: Héctor
authors: H
authors: Olvera-González
authors: Miguel Angel
authors: MA
authors: Villasís-Keever
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D002648:Child; D003430:Cross-Sectional Studies; D003933:Diagnosis; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008511:Medicine; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology; D010372:Pediatrics; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology; D055815:Young Adult