Factors associated with health professionals decision to initiate paediatric advance care planning: A systematic integrative review

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12 Citations (Scopus)
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Background: Advance care planning for children with palliative care needs is an emotionally, legally and complex aspect of care, advocated as beneficial to children, families and health professionals. Evidence suggests healthcare professionals often avoid or delay initiation. An overview of evidence on the factors that influence and impact on the health care professional’s initiation of paediatric advance care planning process is lacking. Aim: To review and synthesise evidence on the factors associated with health care professional’s decision to initiate paediatric advance care planning. Design: Systematic integrative review using constant comparison method. Data Sources: Electronic databases (CINAHL, PubMed, PsycINFO, Ovid MEDLINE, EMBASE, Web of Science and Cochrane) using MeSH terms and word searches in Oct 2019. No limit set on year of publication or country. Grey literature searches were also completed. Results: The search yielded 4153 citations from which 90 full text articles were reviewed. Twenty-one met inclusion criteria consisting of quantitative (n = 8), qualitative (n = 6) and theoretical (n = 7) studies. Findings revealed overarching and interrelated themes ‘The timing of initiation’, ‘What makes an initiator, ‘Professionals’ perceptions’ and ‘Prerequisites to initiation’. Conclusions: This review provides insights into the complexities and factors surrounding the initiation of advance care planning in paediatric practice. Uncertainty regarding prognosis, responsibility and unpredictable parental reactions result in inconsistent practice. Future research is required to inform intervention to assist health care professionals when initiating paediatric advance care planning conversations.

Original languageEnglish
Pages (from-to)503-528
Number of pages26
JournalPalliative Medicine
Issue number3
Early online date29 Dec 2020
Publication statusPublished (in print/issue) - 29 Mar 2021

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by the UK Department of Employment and Learning (DEL) awarded to the lead author to undertake this research as part of a PhD.

Publisher Copyright:
© The Author(s) 2020.


  • Child
  • adolescent
  • advance care planning
  • decision making
  • infant
  • paediatric
  • palliative care
  • terminal care


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