Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
5-Year IF – 2.0, IF – 1.9, JCI (2024) – 0.43
Scopus CiteScore – 4.3
Q1 in SJR 2024, SJR score – 0.598, H-index: 49 (SJR)
ICV – 161.00; MNiSW – 70 pts
Initial editorial assessment and first decision within 24 h

ISSN 1899–5276 (print), ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2014, vol. 23, nr 5, September-October, p. 791–796

Publication type: original article

Language: English

Social and Professional Determinants for Withdrawing and Withholding Chronic Dialysis Among Polish Pediatric Nephrologists, Neonatologists and Anesthesiologists

Marcin Tkaczyk1,2,A,B,C,D,E,F, Anna Jander2,A,B,C,D,E,F, Jakub R. Stempień3,A,B,C,D,E,F

1 Pediatric Didactics Unit, 4th Chair of Pediatrics, Medical University of Łódź, Poland

2 Department of Pediatrics and Immunology, Nephrology Division, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland

3 Department of Sociology, Chair of Humanities, Medical University of Łódź, Poland

Abstract

Objectives. The aim of this multicenter nationwide study was to reveal the influence of social and non-medical factors on qualifying children to commence chronic dialysis, to withhold it or to withdraw it. It was also important to compare the real and postulated significance of particular factors that were taken under consideration by pediatric nephrologists, neonatologists and anesthesiologists (intensivists).
Material and Methods. The survey was addressed to the whole population of specialists dealing with chronic renal replacement therapy for children at key pediatric nephrology centers in Poland.
Results. Most of the respondents accepted that withholding or withdrawing chronic dialysis is an alternative in certain clinical situations. The statistical analysis showed that the physicians’ social characteristics had little influence on their preferences when deciding about withholding or withdrawing chronic dialysis.
Conclusion. The study showed that non-medical factors did not influence physicians’ attitudes to the problem of withholding or withdrawing chronic dialysis.

Key words

children, chronic dialysis, dialysis withholding/withdrawing, pediatric nephrology, non-medical determinants.

References (28)

  1. Bunchman TE: Infant dialysis: The future is now. J Pediatr 2000, 136, 1–2.
  2. Kjellstrand CM: Giving life – giving death. Ethical problems of high technology medicine. Acta Med Scand 1998, 725, 1–88.
  3. Auer J: Ethical issues in dialysis. Issues surrounding the withdrawal of dialysis treatment. Neph Dial Transplant 1998, 13, 1149–1151.
  4. Beauchamps TL, Childress JF: Principles of biomedical ethics. New York, Oxford University Press 2005.
  5. Jander A: The ethics of renal replacement therapy in newborn and infants. Bioet Zesz Pediatr 2008, 5, 59–63.
  6. Jander A, Nowicki M, Tkaczyk M, Makulska I, Zwolinska D, Latoszynska J: Chronic peritoneal dialysis in infants – preliminary results of the multicenter survey. Przegl Lek 2006, 63, 72–74.
  7. Lederman S, Scanes ME, Fernando ON, Duffy PG, Madden SJ, Trompeter RS: Long-term outcome of peritoneal dialysis in infants. J Pediatr 2000, 136, 24–29.
  8. Shroff R, Rees L, Trompeter R, Hutchinson C, Ledermann S: Long-term outcome of chronic dialysis in children. Pediatr Nephrol 2006, 21, 257–264.
  9. Choloniewski J: Ankietowanie pocztowe w Polsce. In: Mangione T. (aut.) Ankietowanie pocztowe w badaniach marketingowych i socjologicznych. Wyd. Nauk. PWN, Warszawa 1999, 162–163.
  10. Keating RF, Moss AH, Sorkin MI: Stopping dialysis of an incompetent patient over a family objection: is it ever ethical or legal? J Am Soc Nephrol 1994, 4, 1879–1883.
  11. Rutecki GW, Cugino A, Jarjoura A: Nephrologists’ subjective attitudes towards end-of-life issues and the conduct of terminal care. Clin Nephrol 1997, 48, 173–180.
  12. Sessa A: When dialysis becomes worse than death. Nephrol Dial Transplant 1995, 10, 1128–1130.
  13. Sjokvist P, Nilstun T, Svantesson A: Withdrawal of life support – who should decide? Differences in attitudes among the general public, nurses and physicians. Int Care Med 1999, 25, 949–954.
  14. Fauriel I, Moutel G, Moutard ML, Montuclard L, Duchange N, Callies I: Decision concerning potentially lifesustaining treatments in pediatric nephrology: multicentre study in French-speaking countries. Nephrol Dial Transplant 2004, 19, 1252–1257.
  15. Geary DF: Attitudes of pediatric nephrologists to management of end stage renal disease in infants. J Pediatr 1998, 133, 154–156.
  16. Grenda R: Ethical aspects of renal replacement therapy in children. Bioet Zesz Pediatr 2008, 5, 64–70.
  17. Riano I, Malaga S, Callis L: Towards guidelines for dialysis in children with end stage renal disease. Pediatr Nephrol 2000, 15, 157–162.
  18. Shooter M, Watson A: The ethics of withholding and withdrawing dialysis therapy in infants. Pediatr Nephrol 2000, 14, 347–351.
  19. Galla JH: Clinical practice guideline on shared decision-making in the appropriate initiation of and withdrawal from dialysis. J Am Soc Nephrol 2000, 11, 1340–1342.
  20. Stuczynska K: Futile therapy – legal aspects. Bioet Zesz Pediatr 2006, 3, 99–110.
  21. Royal College of Pediatrics and Child Health. Withholding or withdrawing life-saving treatment in children: a framework for practice. Royal College of Pediatrics and Child Health, London 1997.
  22. Patel S, Holley JL: Withholding and withhdrawing dialysis in the intensive care unit: benefits derived from consulting the renal physicians Association/American Society of Nephrology Clinical Practice Guideline, shared decisionmaking in the appropriate initiation of and withdrawal from dialysis. Clin J Am Soc Nephrol 2008, 3, 587–593.
  23. Polish Society of Pediatricians. Zaniechanie i wycofanie się z uporczywego leczenia podtrzymującego życie u dzieci. Polskie Towarzystwo Pediatryczne, Warszawa 2011.
  24. Rosenblatt RA, Moscovice IS: The Physician as Gatekeeper: Determinants of Physicians’ Hospitalization Rates. Med Care 1984, 22, 150–159.
  25. Shortell SM: Determinants of Physician Referral Rates: An Exchange Theory Approach Med Care 1974, 12, 13–31.
  26. Heide A, Vrakking A, Delden H, Looman C, Maas P: Medical and nonmedical determinants of decision making about potentially life-prolonging interventions. Med Dec Making 2004, 24, 518–524.
  27. Christakis NA, Lamont EB: Extent and determinants of error in doctors’ prognoses in terminally ill patients. West J Med 2000, 172, 310–313.
  28. Tkaczyk M, Jander A, Stempień JR: Czy wszystkie dzieci z V stadium przewleklej choroby nerek w Polsce powinny być dializowane, w opinii nefrologów, neonatologow i lekarzy intensywnej terapii? Pediatr Med Rodz 2010, 6, 133–140.
© Wroclaw Medical University