# Navigating the shadows: medical professionals’ values and perspectives on end-of-life care within pediatric intensive care units in Croatia

## TL;DR

This study examines how Croatian medical professionals in pediatric ICUs approach end-of-life care, revealing varied experiences and the need for clearer guidelines.

## Contribution

The study provides new insights into the attitudes and practices of Croatian healthcare professionals regarding pediatric end-of-life care.

## Key findings

- Healthcare professionals reported infrequent involvement in life-sustaining treatment limitation discussions.
- Significant differences were found between professional roles and regions in attitudes toward end-of-life care.
- The study highlights the need for better guidelines and support for ethical decision-making in pediatric end-of-life care.

## Abstract

This study explores healthcare professionals’ perspectives on end-of-life care in pediatric intensive care units (ICUs) in Croatia, aiming to illuminate their experiences with such practices, underlying attitudes, and major decision-making considerations. Amid the high variability, complexity, and emotional intensity of pediatric end-of-life decisions and practices, understanding these perspectives is crucial for improving care and policies.

The study utilized a cross-sectional survey intended for physicians and nurses across all pediatric ICUs in Croatia. It included healthcare professionals from six neonatal and four pediatric ICUs in total. As the data from neonatal and pediatric ICUs were examined jointly, the term pediatric ICU was used to denominate both types of ICUs. A statistical analysis was performed using Python and JASP, focusing on professional roles, professional experience, and regional differences.

The study included a total of 103 participants (with an overall response rate—in relation to the whole target population—of 48% for physicians and 29% for nurses). The survey revealed diverse attitudes toward and experiences with various aspects of end-of-life care, with a significant portion of healthcare professionals indicating infrequent involvement in life-sustaining treatment (LST) limitation discussions and decisions, as well as somewhat ambiguous attitudes regarding such practices. Notably, discrepancies emerged between different professional roles and, in particular, regions, underscoring the high variability of LST limitation-related procedures.

The findings highlight a pressing need for more straightforward guidelines, legal frameworks, support mechanisms, and communication strategies to navigate the complex terrain of rather burdensome end-of-life pediatric care, which is intrinsically loaded with profound ethical quandaries.