title: Caring Decisions: The Development of a Written Resource for Parents Facing End-of-Life Decisions.
abstract: BACKGROUND
  Written resources in adult intensive care have been shown to benefit families facing end of life (EoL) decisions. There are few resources for parents making EoL decisions for their child and no existing resources addressing ethical issues. The Caring Decisions handbook and website were developed to fill these gaps.
  
  
  OBJECTIVE
  We discuss the development of the resources, modification after reviewer feedback and findings from initial pilot implementation.
  
  
  METHODS
  A targeted literature review-to identify resources and factors that impact on parental EoL decision-making; development phase-guided by the literature and the researchers' expertise; consultation process-comprised a multi-disciplinary panel of experts and parents; pilot evaluation study-hard-copy handbook was distributed as part of routine care at an Australian Children's Hospital.
  
  
  METHODS
  Twelve experts and parents formed the consultation panel. Eight parents of children with life-limiting conditions and clinicians were interviewed in the pilot study.
  
  
  RESULTS
  Numerous factors supporting/impeding EoL decisions were identified. Caring Decisions addressed issues identified in the literature and by the multidisciplinary research team. The consultation panel provided overwhelmingly positive feedback. Pilot study parents found the resources helpful and comforting. Most clinicians viewed the resources as very beneficial to parents and identified them as ideal for training purposes.
  
  
  CONCLUSIONS
  The development of the resources addressed many of the gaps in existing resources. The consultation process and the pilot study suggest these resources could be of significant benefit to parents and clinicians.
authors.affiliation: 1 Discipline of Obstetrics and Gynaecology, Women's and Children's Hospital, The University of Adelaide , Adelaide, Australia .|2 The Sydney Children's Hospitals Network , Westmead, New South Wales, Australia .
authors.forename: Vicki
authors.initials: V
authors.lastname: Xafis
authors.affiliation: 3 Children's Bioethics Centre, The Royal Children's Hospital , Melbourne, Australia .|5 Centre for Health Equity, University of Melbourne , Melbourne, Australia .
authors.forename: Lynn
authors.initials: L
authors.lastname: Gillam
authors.affiliation: 4 Victorian Paediatric Palliative Care Program, The Royal Children's Hospital , Melbourne, Australia .
authors.forename: Jenny
authors.initials: J
authors.lastname: Hynson
authors.affiliation: 3 Children's Bioethics Centre, The Royal Children's Hospital , Melbourne, Australia .|5 Centre for Health Equity, University of Melbourne , Melbourne, Australia .
authors.forename: Jane
authors.initials: J
authors.lastname: Sullivan
authors.affiliation: 6 Disciplines of Palliative Medicine and General Paediatrics, Women's and Children's Health Network , Adelaide, Australia .
authors.forename: Mary
authors.initials: M
authors.lastname: Cossich
authors.affiliation: 1 Discipline of Obstetrics and Gynaecology, Women's and Children's Hospital, The University of Adelaide , Adelaide, Australia .|7 Medical Ethics Department, Oxford Uehiro Centre for Practical Ethics, Oxford University , Oxford, United Kingdom .|8 John Radcliffe Hospital , Oxford, United Kingdom .
authors.forename: Dominic
authors.initials: D
authors.lastname: Wilkinson
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000941:ethics* / Q000592:standards; D001291:Attitude of Health Personnel; D001315:Australia; D002648:Child; D054626:Consumer Health Information / Q000379:methods*; D003657:Decision Making / Q000941:ethics*; D006801:Humans; D020407:Internet; D010290:Parents / Q000193:education* / Q000523:psychology*; D010865:Pilot Projects; D011368:Professional-Family Relations; D011642:Publications; D013727:Terminal Care / Q000379:methods / Q000592:standards*