389 - Interprofessional Perspectives on Withdrawal of Life Supportive Therapy in the Neonatal Intensive Care Unit: A Survey Study

Publication Number: 4381.389

Kwai Tei Chan Poon, Duke University Hospital, Durham, NC, United States; Sharla Rent, Duke University School of Medicine, Chapel Hill, NC, United States; Monica Lemmon, Duke University School of Medicine, Durham, NC, United States; Susan Izatt, Duke University School of Medicine, Durham, NC, United States; Stephanie Kukora, Children's Mercy Bioethics Center, Kansas City, MO, United States

Background: The Neonatal Intensive Care Unit (NICU) is a common location in children's hospitals where withdrawal of life sustaining therapy (WOLST) occurs. Caring for dying infants is emotionally challenging and attitudes toward WOLST decisions are shaped by clinical education and experiences.

Objective: We aimed to characterize the perspectives of health care team members about frequency, content, and associated moral distress of decisions about WOLST.

Design/Methods: We electronically surveyed interprofessional NICU clinicians anonymously using REDcap software. Items were developed based on the literature and discussion with bioethicists and practicing clinicians. The survey included Lickert-scale and ranking questions exploring perceptions around WOLST scenarios and discussions, practices around WOLST, moral distress, clinical ethics consultation and demographic characteristics. Results were exported and analyzed in Excel using descriptive statistics.

Results: There were 139 completed surveys (36% response rate). Demographic information reported in Table 1. Most respondents reported caring for 1-5 (58.3%) or 6-10 (24.5%) infants in the last year that required a family meeting to discuss WOLST; fewer reported caring for no patients (12.9%) or more than 10 patients (4.3%) for whom WOLST was discussed. Respondents noted that discussions were more common with some diagnoses compared to others, the most common being (Figure 1A). "Faith/Religion," and "Cultural Traditions and Norms" were perceived as the most common causes of disagreement in discussions with families around pursing WOLST when recommended (Figure 1B). The majority of respondents disagreed or strongly disagreed that providers held WOLST discussions in a timely manner, though most strongly agreed or agreed that providers were experienced and comfortable with pain management in WOLST and that Palliative Care is optimally involved (Figure 2A).
Respondents indicated agreement/disagreement with whether common NICU scenarios caused personal moral distress (Figure 2B); most respondents agreed or strongly agreed that they had experienced moral distress with parents declining WOLST when recommended. Most respondents knew about the institutional ethics committee (87.6%), though few had called a consult (22.1%). A minority provided care in the last year for a patient on which an ethics consultation was requested (30.6%), with very few (3.7%) caring for more than three.

Conclusion(s): Interprofessional clinicians hold diverse views around WOLST and experience moral distress in the NICU. Future strategies to harmonize clinical care with ethical support are needed.

Table 1.
Demographic characteristics of respondents.

Figure 1 A and B.
A. Respondents' ranked frequency of scenarios leading to WOLST discussions. B. Respondents' ranked commonness of causes of disagreements between families and teams in WOLST discussions.


Figure 2 A and B.
A. Interprofessional NICU clinicians' perceptions of end-of-life care provision. B. Interprofessional NICU clinicians' perceptions of moral distress in common NICU scenarios.