title: Pediatrician Ambiguity in Understanding Palliative Sedation at the End of Life.
abstract: BACKGROUND
  Palliative sedation is a means of relieving intractable symptoms at the end of life, however, guidelines about its use lack consistency. In addition, ethical concerns persist around the practice. There are reports of palliative sedation in the pediatric literature, which highlight various institutional perspectives.
  
  
  OBJECTIVE
  This survey of 4786 pediatric providers sought to describe their knowledge of and current practices around pediatric palliative sedation.
  
  
  METHODS
  Our survey was administered to pediatricians who care for children at the end of life. The survey assessed agreement with a definition of palliative sedation, as well as thoughts about its alignment with aggressive symptom management. Bivariate analyses using χ2and analysis of variance were calculated to determine the relationship between responses to closed-ended questions. Open-ended responses were thematically coded by the investigators and reviewed for agreement.
  
  
  RESULTS
  Nearly half (48.6%) of the respondents indicated that the stated definition of palliative sedation "completely" reflected their own views. Respondents were split when asked if they viewed any difference between palliative sedation and aggressive symptom management: Yes (46%) versus No (54%). Open-ended responses revealed specifics about the nature of variation in interpretation.
  
  
  CONCLUSIONS
  Responses point to ambiguity surrounding the concept of palliative sedation. Pediatricians were concerned with a decreased level of consciousness as the goal of palliative sedation. Respondents were split on whether they view palliative sedation as a distinct entity or as one broad continuum of care, equivalent to aggressive symptom management. Institutional-based policies are essential to clarify acceptable practice, enable open communication, and promote further research.
authors.affiliation: 1 Department of Pediatrics, Division of Critical Care Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Carrie M
authors.initials: CM
authors.lastname: Henderson
authors.affiliation: 2 Department of Pediatrics, Divisions of Emergency Medicine (MF) and Hospice and Palliative Medicine (NW), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: FitzGerald
authors.affiliation: 3 Department of Pediatrics, Division of Critical Care Medicine, University of Kansas Medical Center, Prairie Village, KS, USA.
authors.forename: K Sarah
authors.initials: KS
authors.lastname: Hoehn
authors.affiliation: 2 Department of Pediatrics, Divisions of Emergency Medicine (MF) and Hospice and Palliative Medicine (NW), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Norbert
authors.initials: N
authors.lastname: Weidner
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D016292:Procedural Sedation / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010372:Pediatrics / Q000379:methods* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods*
keywords: end-of-life; ethics; palliative sedation; pediatric; pediatrician; viewpoint