Shared decision-making in pediatric palliative care in the Netherlands

Michiels EM , Joren CY , Kars MC , Aris JL , Verhagen AAE
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Abstract

Shared decision-making (SDM) is a process in which health care professionals (HCPs) involve parents and children - when appropriate- to decide together on future treatment. These decisions are based on values that are important for the family, goals of care and preferences for future care and treatment. Elucidation of these values and preferences is preferably done early in the disease trajectory via so-called Advance Care Planning (ACP) conversations.

In the Netherlands, ACP and SDM are being adopted by most health care professionals. This has happened only recently. Ten years ago, ACP and SDM were unknown concepts for the vast majority of Dutch HCPs. Today, interest in these conversational approaches is booming in both daily practice and in research.

This rise has been reinforced by two recent major advancements in Dutch pediatric palliative care: the Individual Care Plan (ICP) and the Dutch Evidence-Based Guideline on Pediatric Palliative Care (DGPPC).

Despite this positive evolution, a lot of work is still ahead. ACP and SDM demand a change in mindset from the traditional paternalistic approach by which the HCP ‘knows what is best for this child’ to a more humble and open approach in which (non-medical) factors that are important to the child and family and may influence the final treatment decision. Such changes in mindset don't happen overnight.

In this article we describe the situation of pediatric palliative care in the Netherlands, with focus on the recent evolution of ACP and SDM.

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荷兰儿科姑息治疗中的共同决策。
共同决策(SDM)是一个过程,在这个过程中,医疗保健专业人员(HCPs)会在适当的时候让家长和孩子参与进来,共同决定未来的治疗方案。这些决定基于对家庭重要的价值观、护理目标以及对未来护理和治疗的偏好。这些价值观和偏好最好在疾病早期通过所谓的 "预先护理规划"(ACP)对话来阐明。在荷兰,ACP 和 SDM 正在被大多数医护人员所采用。这只是最近才发生的事情。十年前,ACP 和 SDM 对绝大多数荷兰医护人员来说还是未知的概念。如今,无论是在日常实践中还是在研究中,人们对这些对话式方法的兴趣都在蓬勃发展。最近,荷兰儿科姑息关怀领域的两项重大进展:个体关怀计划(ICP)和荷兰儿科姑息关怀循证指南(DGPPC),进一步推动了这一趋势的发展。尽管取得了这一积极进展,但仍有许多工作要做。ACP 和 SDM 要求改变思维方式,从传统的家长式方法(即保健医生 "知道什么对这个孩子最好")转变为更加谦逊和开放的方法,在这种方法中,(非医疗)因素对孩子和家庭非常重要,并可能影响最终的治疗决定。这种心态的转变并非一蹴而就。在这篇文章中,我们将描述荷兰儿科姑息关怀的现状,并重点介绍ACP和SDM的最新发展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.60
自引率
0.00%
发文量
61
审稿时长
5 days
期刊介绍: Recognized for its probing, comprehensive, and evidence-based reviews, Current Problems in Pediatric and Adolescent Health Care devotes each issue to a timely and practical topic in pediatric medicine, presented by leading authorities in the field. The journal offers readers easily accessible information that enhances professional experience and is pertinent to daily pediatric practice. Each issue''s review article is accompanied by an additional special feature designed to highlight a particular aspect of the topic presented.
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