Current Problems in Pediatric and Adolescent Health Care最新文献

Pediatric palliative care (PPC) emerged during the late 20th century in Canada. It has steadily expanded and there are now programs in every province. Programs adhere to recognized standards of practice at both federal and provincial levels. PPC is recognized by government regulatory bodies and professional associations, including the Canadian Paediatric Society.

Pediatric palliative care has grown immensely in recent years in the world. However, shared decision-making remains a complex process, especially in pediatric palliative care. In particular, a number of issues are priorities to improve the shared decision-making process and ensure high-quality pediatric palliative care for every child. Working on these priorities will improve shared decision-making and thereby enhance high-quality pediatric palliative care around the globe.

In this article, we highlight the Australian pediatric palliative care context. We describe the way in which pediatricians may adopt ‘directive’ shared decision-making to align care plans with their perceptions of harm avoidance for the child. The degree to which ‘directive alignment’ is ethically appropriate or proportionate in the context of the clinical and social context of the child must be considered. Shared decision-making within palliative care continues to be a challenging dynamic to navigate for pediatricians.

Shared decision-making (SDM) with parents and adolescents is normative in pediatric practice in North America. In this article we discuss how it is applicable to the practice of pediatric palliative care (PPC). As PPC itself is exemplary of patient-and-family-centered care, it often uses a SDM approach in clarifying patient and family preferences, goals, and values. This often occurs in an iterative process and across care environments, wherein the patient and family narrative is elaborated. Decisions are then made incorporating both evidence-based medical practice and the unique attributes and considerations of the patient and family.

Despite the significant growth and development of pediatric palliative care worldwide, significant challenges remain. One of those challenges is shared decision-making, by which parents, families and professionals all work together to develop a plan of care that reflects both the medical facts and the patient’s family’s values. Shared decision-making about palliative care and about death and dying may mean different things in different cultures and countries. It is therefore important to learn and compare practices around the world.

Since the 1980s, there has been a growing recognition of the importance of palliative care for children with life-limiting and life-threatening conditions. Collaboration, regulatory frameworks, educational initiatives and a patient-centered approach have contributed to the advancement of PPC services for children with life-limiting conditions. In spite of this progress, pediatric palliative care in Argentina is not yet fully integrated into our health care system.

This article sheds light on Pakistan's challenging healthcare landscape, focusing on the underdeveloped state of pediatric palliative care (PPC). Despite being the fifth most populous country, Pakistan allocates minimal resources to its healthcare system, resulting in severe shortages of healthcare professionals. The scarcity of PPC services, exacerbated by cultural, social, and financial factors, poses substantial challenges to providing quality end-of-life care to children. However, the article also offers a glimpse of hope, highlighting the growing awareness among healthcare providers and ongoing efforts to bridge the gaps in PPC services, ultimately aiming to improve the quality of life for those in need.

The safe keeping of children and families that require Pediatric Palliative Care (PPC), presents a challenge to the healthcare professionals and systems, particularly in countries like Mexico. This is due to social inequities, the cultural diversity, the geo-regional position that determine specific social dynamics and nowadays the huge immigration issues that we are facing.

The combination of all these factors, requires a vast knowledge from PPC providers about the necessary tools to properly provide the support needed in the most effective and efficient way, based on compassion. Knowing how to accurately understand the needs of children and their families requiring PPC and how to best assist them during the decision-making process is extremely important.

At the same time, all PPC team members require expertise in addressing pediatric pathophysiology and bioethical issues that apply to diverse and heterogeneous age groups.