The involvement and autonomy of young children undergoing elective paediatric cardiac surgery: a qualitative study.
Cardiac surgery
Consent
Ethics
Paediatrics
Qualitative research
Journal
Journal of cardiothoracic surgery
ISSN: 1749-8090
Titre abrégé: J Cardiothorac Surg
Pays: England
ID NLM: 101265113
Informations de publication
Date de publication:
31 May 2022
31 May 2022
Historique:
received:
30
11
2021
accepted:
19
05
2022
entrez:
1
6
2022
pubmed:
2
6
2022
medline:
3
6
2022
Statut:
epublish
Résumé
Standards generally reported in the literature about informing children and respecting their consent or refusal before elective heart surgery may differ from actual practice. This research aims to summarize the main themes in the literature about paediatric anaesthesia and compare these with research findings on how health professionals counsel young children before elective heart surgery, respect their consent or refusal, and maintain patient-centred care. This qualitative research involved: literature reviews about children's consent to surgery and major interventions; observations of wards, clinics and medical meetings in two paediatric cardiology departments, October 2019 to February 2020; audio-recorded semi-structured interviews with 45 hospital staff, including 5 anaesthetists, and related experts, November 2019 to April 2021; interviews with 16 families, with children aged 6- to 15-years and their parents shortly after elective heart surgery, and some months later (reported in other papers); thematic data analysis; and research reports on how different professions contribute to children's informed decisions for heart surgery. The medical, ethics and English legal literature tend to assume legal minors cannot refuse major recommended treatment, and cannot consent until they are 12 years or older. Little is said about informing pre-competent children. If children resist, some anaesthetists rely on sedation and distraction, and avoid much informed discussion, aiming to reduce peri-operative anxiety. However, interviewees reported informing young children, and respecting their consent or refusal before elective surgery. They may delay elective surgery and provide further information and support, aiming to reduce fear and promote trust. Six years of age was commonly cited as the threshold for respecting consent to heart transplantation. Differing views about younger children's competence, anxiety and best interests support different reactions to children's consent and refusal before elective heart surgery. This paper reports the zero-restraint policy followed for over a decade in at least one leading surgery centre. The related law and literature need to be updated, to take more account of evidence of actual practice.
Sections du résumé
BACKGROUND
BACKGROUND
Standards generally reported in the literature about informing children and respecting their consent or refusal before elective heart surgery may differ from actual practice. This research aims to summarize the main themes in the literature about paediatric anaesthesia and compare these with research findings on how health professionals counsel young children before elective heart surgery, respect their consent or refusal, and maintain patient-centred care.
METHODS
METHODS
This qualitative research involved: literature reviews about children's consent to surgery and major interventions; observations of wards, clinics and medical meetings in two paediatric cardiology departments, October 2019 to February 2020; audio-recorded semi-structured interviews with 45 hospital staff, including 5 anaesthetists, and related experts, November 2019 to April 2021; interviews with 16 families, with children aged 6- to 15-years and their parents shortly after elective heart surgery, and some months later (reported in other papers); thematic data analysis; and research reports on how different professions contribute to children's informed decisions for heart surgery.
RESULTS
RESULTS
The medical, ethics and English legal literature tend to assume legal minors cannot refuse major recommended treatment, and cannot consent until they are 12 years or older. Little is said about informing pre-competent children. If children resist, some anaesthetists rely on sedation and distraction, and avoid much informed discussion, aiming to reduce peri-operative anxiety. However, interviewees reported informing young children, and respecting their consent or refusal before elective surgery. They may delay elective surgery and provide further information and support, aiming to reduce fear and promote trust. Six years of age was commonly cited as the threshold for respecting consent to heart transplantation.
CONCLUSION
CONCLUSIONS
Differing views about younger children's competence, anxiety and best interests support different reactions to children's consent and refusal before elective heart surgery. This paper reports the zero-restraint policy followed for over a decade in at least one leading surgery centre. The related law and literature need to be updated, to take more account of evidence of actual practice.
Identifiants
pubmed: 35641980
doi: 10.1186/s13019-022-01889-5
pii: 10.1186/s13019-022-01889-5
pmc: PMC9153234
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
136Subventions
Organisme : British Heart Foundation UK
ID : project code: 546781/award number: 176835.
Informations de copyright
© 2022. The Author(s).
Références
Br J Anaesth. 2018 Jan;120(1):164-172
pubmed: 29397125
Br J Nurs. 2013 Nov 14-27;22(20):1153-8
pubmed: 24225549
Anesthesiology. 2011 Jul;115(1):18-27
pubmed: 21606826
Curr Opin Anaesthesiol. 2011 Jun;24(3):301-6
pubmed: 21494130
World J Clin Pediatr. 2016 May 08;5(2):143-50
pubmed: 27170924
Anesth Analg. 2014 Sep;119(3):643-650
pubmed: 25010821
Paediatr Anaesth. 2020 Sep;30(9):998-1005
pubmed: 32463955
Nurs Ethics. 2020 Feb;27(1):230-246
pubmed: 30975025
J R Soc Med. 2015 Nov;108(11):451-6
pubmed: 26432814
Paediatr Anaesth. 2021 Sep;31(9):1016-1017
pubmed: 34409703
Anesth Analg. 2021 Mar 1;132(3):798-806
pubmed: 32618627
Nurs Inq. 2015 Jun;22(2):157-67
pubmed: 25053126
Anesth Analg. 2014 Dec;119(6):1407-19
pubmed: 25289661
J Child Health Care. 2022 Mar;26(1):96-109
pubmed: 33745339
Paediatr Anaesth. 2007 Dec;17(12):1134-42
pubmed: 17986031
Anesthesiology. 2011 Jul;115(1):4-5
pubmed: 21572313
Arch Dis Child. 2011 Oct;96(10):960-2
pubmed: 21775300
Pediatrics. 2005 Oct;116(4):e563-7
pubmed: 16199685
J Paediatr Child Health. 2019 Oct;55(10):1165-1169
pubmed: 31482670
Br J Anaesth. 2017 Feb;118(2):247-253
pubmed: 28100529
BMC Med Ethics. 2015 Nov 09;16(1):76
pubmed: 26553304
Anesth Analg. 2018 Dec;127(6):1398-1405
pubmed: 30113400
Paediatr Anaesth. 2017 Dec;27(12):1253-1260
pubmed: 29076261
Turk J Anaesthesiol Reanim. 2018 Aug;46(4):305-310
pubmed: 30140538
Paediatr Anaesth. 2018 Feb;28(2):149-156
pubmed: 29266767
BMJ. 1999 Jul 24;319(7204):209
pubmed: 10417066
Paediatr Anaesth. 2009 Oct;19(10):1017-21
pubmed: 19422599
Nurs Ethics. 2022 Jun;29(4):1078-1090
pubmed: 35212562
Arch Dis Child. 2012 Jan;97(1):1-4
pubmed: 22082500
Anesth Analg. 2018 Dec;127(6):1289-1291
pubmed: 30433919
Paediatr Anaesth. 2021 Aug;31(8):834-838
pubmed: 33949034
Arch Dis Child. 2019 May;104(5):413-416
pubmed: 31000533
BMJ. 2008 Nov 12;337:a2526
pubmed: 19004894