title: Advance Care Planning in palliative care: a qualitative investigation into the perspective of Paediatric Intensive Care Unit staff.
abstract: BACKGROUND
  The majority of children and young people who die in the United Kingdom have pre-existing life-limiting illness. Currently, most such deaths occur in hospital, most frequently within the intensive care environment.
  
  
  OBJECTIVE
  To explore the experiences of senior medical and nursing staff regarding the challenges associated with Advance Care Planning in relation to children and young people with life-limiting illnesses in the Paediatric Intensive Care Unit environment and opportunities for improvement.
  
  
  METHODS
  Qualitative one-to-one, semi-structured interviews were conducted with Paediatric Intensive Care Unit consultants and senior nurses, to gain rich, contextual data. Thematic content analysis was carried out.
  
  
  METHODS
  UK tertiary referral centre Paediatric Intensive Care Unit. Eight Paediatric Intensive Care Unit consultants and six senior nurses participated.
  
  
  RESULTS
  Four main themes emerged: recognition of an illness as 'life-limiting'; Advance Care Planning as a multi-disciplinary, structured process; the value of Advance Care Planning and adverse consequences of inadequate Advance Care Planning. Potential benefits of Advance Care Planning include providing the opportunity to make decisions regarding end-of-life care in a timely fashion and in partnership with patients, where possible, and their families. Barriers to the process include the recognition of the life-limiting nature of an illness and gaining consensus of medical opinion. Organisational improvements towards earlier recognition of life-limiting illness and subsequent Advance Care Planning were recommended, including education and training, as well as the need for wider societal debate.
  
  
  CONCLUSIONS
  Advance Care Planning for children and young people with life-limiting conditions has the potential to improve care for patients and their families, providing the opportunity to make decisions based on clear information at an appropriate time, and avoid potentially harmful intensive clinical interventions at the end of life.
authors.affiliation: Birmingham Children's Hospital, Birmingham, UK Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK S.Mitchell6@nhs.net.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mitchell
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Dale
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000592:standards; D001291:Attitude of Health Personnel; D002648:Child; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods / Q000592:standards*; D006113:United Kingdom
keywords: Advance Care Planning; Paediatric Intensive Care Units; end-of-life care; paediatric nursing; paediatrics; palliative care; terminal care