Table 3 Analysis of survey data on LST decisions in Italian Pediatric Intensive Care

  NO12 – AS1

The decision is discussed first with the parents [Scale 1]

3.692308

  NO12 – AS2

The decision is discussed first with the parents [Scale 2]

3.815385

  NO12 – BS1

The decision is discussed first with other physicians in the PICU team [Scale 1]

3.830769

  *NO12 – BS2

The decision is discussed first with other physicians in the PICU team [Scale 2]

3.984615

Nurses ranked this item lower than physicians.

  NO12 – CS1

The decision is discussed first with the nurses [Scale 1]

3.0

  NO12 – CS2

The decision is discussed first with the nurses [Scale 2]

3.184615

  NO13 – AS1

The responsibility for the decision is entrusted to the individual physician [Scale 1]

2.0

  NO13 – AS2

The responsibility for the decision is entrusted to the individual physician [Scale 2]

1.923077

  NO13 – BS1

The responsibility for the decision is shared with other physicians in the PICU team [Scale 1]

3.892308

  *NO13 –BS2

The responsibility for the decision is shared with other physicians in the PICU team [Scale 2]

4.015385

Nurses ranked this item lower than physicians.

  NO13 – CS1

The responsibility for the decision is shared with the parents [Scale 1]

3.707692

  NO13 – CS2

The responsibility for the decision is shared with the parents [Scale 2]

3.8

  NO13 – DS1

The responsibility for the decision is shared with the nurses [Scale 1]

3.153846

  NO13 – DS2

The responsibility for the decision is shared with the nurses [Scale 2]

3.230769

  *NO14  – A

In our PICU, it is permissible to not initiate LSTs

3.122449

Nurses ranked this item lower than physicians.

  NO14 – B

In our PICU, it is permissible to withdraw LSTs

3.357143

  NO14 – C

Parents are always informed of the LSTs decision

3.918367

  NO14 – D

When LSTs are withheld in a patient, this decision is documented in the patient record

3.663265

  NO14 – E

When LSTs are discussed, an ethics consultation is requested

2.938776

  NO15 – A

After a decision regarding LSTs has been made, a follow-up meeting with the parents is planned

3.357143

  NO15 – B

After a decision regarding LSTs has been made, a follow-up meeting with staff is planned

3.102041

  *NO16 –BS1

The decision should be discussed first with other physicians in the PICU team [Scale 1]

4.430769

Nurses ranked this item lower than physicians.

  *NO16 –BS2

The decision should be discussed first with other physicians in the PICU team [Scale 2]

4.584615

Nurses ranked this item lower than physicians.

  NO16 –AS1

The decision should be discussed first with the parents [Scale 1]

4.169231

  NO16 –AS2

The decision should be discussed first with the parents [Scale 2]

4.307692

  NO16 –CS1

The decision should be discussed first with the nurses [Scale 1]

4.292308

  NO16 –CS2

The decision should be discussed first with the nurses [Scale 2]

4.338462

  NO17 - AS1

The responsibility for the decision should be entrusted to the individual physician [Scale 1]

1.369231

  NO17 – AS2

The responsibility for the decision should be entrusted to the individual physician [Scale 2]

1.384615

  NO17 - BS1

The responsibility for the decision should be shared with other physicians in the PICU team [Scale 1]

4.492308

  *NO17 – BS2

The responsibility for the decision should be shared with other physicians in the PICU team [Scale 2]

4.553846

Nurses ranked this item lower than physicians.

  NO17 – CS1

Responsibility for the decision should be shared with parents [Scale 1]

4.138462

  NO17 – CS2

Responsibility for the decision should be shared with parents [Scale 2]

4.153846

  NO17 – DS1

Responsibility for decision should be shared with nurses [Scale 1]

4.384615

  NO17 – DS2

Responsibility for decision should be shared with nurses [Scale 2]

4.415385

  NO18 - A

In our PICU, it should be permissible to not initiate LSTs

4.071429

  NO18 – B

In our PICU, it should be permissible to withdraw LSTs

4.22449

  NO18 – C

Parents should always be informed of the decision

4.306122

  NO18 – D

When LSTs are withheld in a patient, this decision should be documented in the patient record

4.285714

  NO18 – E

When LSTs are discussed, an ethics consultation should be sought

4.030612

  NO19-A

After a decision regarding LSTs has been made, there should be a follow-up meeting with the parents

4.234694

  NO19-B

After a decision regarding LSTs has been made, there should be a follow-up meeting with staff

4.326531

  NO20 – A

Full LSTs are provided for all patients at all times.

3.530612

  NO20 – B

LSTs are not initiated and/or not augmented if the patient has a severe neurological injury

2.693878

  NO20 – C

LSTs are withdrawn if the patient has a severe neurological injury

2.846939

  NO20 – D

LSTs are not initiated and/or not augmented if the patient does not respond to treatment

2.581633

  NO20 – E

LSTs are withdrawn if the patient does not respond to treatment

2.714286

  NO20 – F

LSTs are not initiated and/or not augmented if it is understood that the patient will not survive the treatment

2.94898

  *NO20 – G

LSTs are withdrawn if it is understood that the patient will not survive the treatment

3.040816

Nurses ranked this item higher than physicians.

  *NO20 – H

LSTs are not initiated and/or not augmented if the treatment would only contribute to prolonging the patient’s suffering

3.020408

Nurses ranked this item higher than physicians.

  *NO20 – I

LSTs are withheld if the treatment would only contribute to prolonging the patient’s suffering

3.081633

Nurses ranked this item higher than physicians.

  NO20 – J

LSTs are not initiated and/or not augmented if the treatment does not ensure the minimum requirements for a dignified life (for example: at least a partial relational life and autonomy, absence of uncontrolled pain)

2.673469

  NO20 – K

LSTs are withdrawn if the treatment does not ensure the minimum requirements for a dignified life (for example: at least a partial relational life and autonomy, absence of uncontrolled pain)

2.806122

  NO20 – L

LSTs are not initiated and/or not augmented if parents ask for LSTs to be stopped

3.081633

  NO20 – M

LSTs are withdrawn if parents ask for LSTs to be stopped

3.040816

  NO22 – A

Full LSTs should be provided for all patients at all times

3.081633

  NO22 – B

LSTs should be limited (i.e., not initiated or not augmented) if the patient has a severe neurological injury

2.673469

  NO22 – C

LSTs should be withdrawn if the patient has a severe neurological injury

2.806122

  *NO22 – D

LSTs should be limited (i.e., not initiated or not augmented) if the patient does not respond to therapy

3.081633

Nurses ranked this item lower than physicians.

  *NO22 – E

LSTs should be withdrawn if the patient does not respond to therapy

3.040816

Nurses ranked this item lower than physicians.

  NO22 – F

LSTs should be limited (i.e., not initiated or not augmented) if the patient would not survive the treatment

3.081633

  *NO22 – G

LSTs should be withdrawn if the patient would not survive the treatment

2.673469

Nurses ranked this item lower than physicians.

  NO22 – H

LSTs should be limited (i.e., not initiated or not augmented) if the treatment would only contribute to prolonging the patient’s suffering

2.806122

  NO22 – I

LSTs should be withdrawn if treatment only contributes to prolonging the patient’s suffering

4.265306

  NO22 – J

LSTs should be limited (i.e., not initiated or not augmented) if the treatment does not ensure the minimum requirements for a dignified life

4

 NO22 - K

LSTs should be withdrawn if the treatment does not ensure the minimum requirements for a dignified life

3.989796

  NO22 – L

LSTs should be limited (i.e., not initiated or not augmented) if parents ask for LSTs to be stopped

3.55102

  NO22 – M

LSTs should be withdrawn if parents ask for LSTs to be stopped

3.489796

  NO24 – A

Having the responsibility to make the final decision

4.030612

  NO24 – B

Not being able to share the decision with others

3.683673

  NO24 – C

Lack of clinical ethics consultation

3.5

  NO24 – D

The fear of making a wrong choice

3.806122

  NO24 – E

Being forced to cause ‘accanimento terapeutico’ (NB: this is an Italian expression referring to persistent needless excessively burdensome interventions, for which there is no directly equivalent term in English) deriving from an orientation of opposition to the withdrawal of LSTs in our PICU

3.877551

  NO24 – F

Being forced to cause ‘accanimento terapeutico’ resulting from the opposition of the parents regarding the withdrawal of LSTs in our PICU

3.908163

  NO24 – G

Being forced to cause ‘accanimento terapeutico’ for other reasons

3.632653

  *NO26 – A

Having persistent concerns about possible harms caused to a patient by our actions or decisions

3.704082

Nurses ranked this item higher than physicians.

  *NO26 – B

Having persistent concerns about possible harms caused to a family by our actions or decisions

3.755102

Nurses ranked this item higher than physicians.

  NO26 – C

Feeling excluded from the decision-making process

3.459184

  NO26 – D

The difficulty in defining solid criteria standards for LST decisions

3.989796

  NO26 – E

Having the perception and conviction of using the available (health) resources in an unfair manner

3.642857

  NO26 – F

Having the fear of medical-legal consequences resulting from our choices

3.428571

  NO26 – G

When my interlocutor (example: parents) has religious convictions that are profoundly different from mine

3.316327

  NO26 – H

Fear and fatigue due to the conflict that these choices generate in the team

3.5

  NO26 – I

Having no legislative standards for LST decisions

3.938776

  NO26 – J

Feeling the need for a legislative framework for end-of-life decision making (example: initiating or withdrawing LSTs)

4.193878

  NO28 – A

I know the recommendations on the initiation, continuation and withdrawal of LSTs developed in recent years by SIAARTI and SARNePI

2.816327

  NO28 – B

I use the recommendations on the initiation, continuation and withdrawal of LSTs developed in recent years by SIAARTI and SARNePI

2.734694

  NO28 – C

In our PICU, it is customary to use the recommendations on the initiation, continuation and withdrawal of LSTs developed in recent years by SIAARTI and SARNePI

2.867347