Dataset Information

Reasons for parental withdrawal of care in a pediatric intensive care unit in China.

ABSTRACT:

Background

The past decade saw the establishment of pediatric intensive care units (PICU) across China. This occurred in the context of increasing private shares of medical costs. Payment schemes have not kept pace with the increased availability and demand. As a result a substantial number of parents, in the face of financial constraints, choose to withdraw the medical care of children even when recovery is expected.

Objective

We set out to describe the experience of one PICU in Changsha, an industrialized city near the center of the country with a population of 7.3 million.

Results

During the two-year period 883 patients were admitted to the PICU. One hundred one (11%) patients died during their hospital stay. Of these 69 (68%) died after parents elected to withdraw care. A large proportion (33 out of 69 48%) cited economic factors as a reason behind the decision. Compared with the non-withdrawal group the cases had lower disease severity at admission and on the day of death. On the day of death 34% in the withdrawal group had lower disease severity than at admission, showing clinical improvement. The mean hospital charge for the ICU stay was RMB35,000 (~$5600).

Conclusion

A substantial proportion of patients in a Chinese urban PICU died after parents chose to withdraw their care in the face of financial hardship, even while some were showing clinical improvement. The society has an obligation, and, likely, an economic incentive, to share this burden.

SUBMITTER: Ho K

PROVIDER: S-EPMC6059386 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

Reasons for parental withdrawal of care in a pediatric intensive care unit in China.

Ho Kiti K Wang Xia X Chen Lei L

PloS one 20180725 7

<h4>Background</h4>The past decade saw the establishment of pediatric intensive care units (PICU) across China. This occurred in the context of increasing private shares of medical costs. Payment schemes have not kept pace with the increased availability and demand. As a result a substantial number of parents, in the face of financial constraints, choose to withdraw the medical care of children even when recovery is expected.<h4>Objective</h4>We set out to describe the experience of one PICU in ...[more]

PMID: 30044777

Similar Datasets

Project description:Parental presence at the bedside (PPB) of critically ill children in the pediatric intensive care unit (PICU) is necessary for operationalizing family-centred care. Previous evidence syntheses emphasize parent-healthcare provider interactions at rounds and resuscitation; our focus is the parent-child dyad. Prior to embarking on further study, we performed a scoping review to determine the breadth and scope of the literature addressing PPB of critically ill children in the PICU. We searched five online databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, and PSYCHINFO) and the grey literature to identify English and French reports from January 1960 to June 2020 addressing physical parental presence with children (birth to 18 years) in intensive care units, without limitation by methodology. Screening, reference selection, and data extraction were performed by two independent reviewers. Data were extracted into a researcher-designed tool. We identified 204 publications (81 quantitative, 68 qualitative, 22 mixed methods, and 9 descriptive case or practice change studies, and a further 24 non-study reports). PPB was directly assessed in 78 (38%) reports, and was the primary objective in 64 (31%). Amount or quality of presence was addressed by 114 reports, barriers and enablers by 152 sources, and impacts and outcomes by 134 sources. While only 6 reports were published in the first two decades of our search (1960-1980), 17 reports were published in 2019 alone. Conclusions: A relatively large body of literature exists addressing PPB of critically ill children. Separate systematic evidence syntheses to assess each element of PPB are warranted. Scoping review protocol registration: Open science framework, protocol nx6v3, registered 9-September-2019. What is Known: • Parental presence at the bedside of critically ill children must be enabled to facilitate family centeredness in care. • Systematic evidence syntheses have focused on parental presence at rounds or resuscitation, rather than with the child throughout the intensive care journey. What is New: • Many reports (n=204) address parental presence at the bedside in the pediatric intensive care unit, though most do as incidental findings • Identifies studies addressing key elements of parental presence in the PICU including barriers and enablers to, amount and quality of, and impact and outcomes of parental presence, and demonstrates trends over time and geography.

Dataset Information

Reasons for parental withdrawal of care in a pediatric intensive care unit in China.

Background

Objective

Results

Conclusion

Publications

Reasons for parental withdrawal of care in a pediatric intensive care unit in China.

Similar Datasets

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