The ethical challenges of palliative care from the perspectives of pediatricians: A qualitative study in Iran

Farzaneh Zahedi; Maliheh Kadivar; Leila Khanali Mojen; Mahsa Asadabadi; Saleheh Tajalli; Mahnaz Ilkhani; Salman Barasteh; Maryam Elahikhah; Bagher Larijani

doi:10.3389/fped.2022.928476

The ethical challenges of palliative care from the perspectives of pediatricians: A qualitative study in Iran

Front Pediatr. 2022 Aug 29:10:928476. doi: 10.3389/fped.2022.928476. eCollection 2022.

Authors

Affiliations

¹ Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
² Division of Neonatology, Department of Pediatrics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
³ School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁴ Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁵ Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran.
⁶ Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
⁷ Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
⁸ Students Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran.
⁹ Medical Ethics and History of Medicine Research Centre, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Background: Adherence to ethical principles is a requirement for palliative care delivery to children and a main concern of healthcare providers. Physicians usually face ethical challenges during their daily practice in hospitals and need adequate skills and the ability to identify and manage them. This study sought to explore the ethical challenges of palliative care from the perspectives of pediatricians.

Methods: This qualitative study was conducted between April and July 2019 using the content analysis approach. Participants were fifteen pediatric medical residents, specialists, and subspecialists purposively recruited from pediatric hospitals in Tehran, Iran. Data were collected using in-depth semi-structured interviews and were analyzed using Graneheim and Lundman's approach to conventional content analysis. Trustworthiness was ensured through the four criteria proposed by Guba and Lincoln.

Results: Participants' experiences of the ethical challenges of palliative care for children were grouped into two main categories, namely "bewilderment in dealing with children and their families" (with two subcategories) and "conflicts in decision making" (with three subcategories). The final five subcategories were: (a) inability to effectively communicate with children and their families, (b) inability to tell the truth about the disease, (c) physician-parent conflicts, (d) parent-child conflicts, and (e) physician-physician conflicts.

Conclusion: The main ethical challenges of palliative care from the perspectives of Iranian pediatricians are the inability to effectively communicate with children and their families, the inability to tell them the truth, and the inability to manage physician-parent, parent-child, and physician-physician conflicts. Identification and management of these challenges may help improve the quality of pediatric palliative care in Iran. Further studies are needed to confirm these findings in other settings.

Keywords: end of life; ethical challenge; ethical issues; life-limiting; palliative care; pediatrician; qualitative study.