Health professionals’ perception of appropriateness of care: a qualitative study in Italian pediatric hospices

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Valentina Cappi
Serena Riboni
Marianna Grana
Emanuela Pierotti
Andrea Ravelli
Stefania Sutti
Sara Testa
Alessio Spacci
Giovanna Artioli
Leopoldo Sarli
Federico Pellegatta


Appropriateness, Perceptions, Health Professionals, Palliative Care, Pediatric Hospice, Italy, Qualitative study, Interviews


Background: Appropriateness is particularly relevant in palliative care, an area in which it is essential to question the real need for treatments. Few studies explored the perception of appropriateness by professionals in pediatric palliative care, revealing the conflict sometimes faced when confronted with the uncertainty of prognosis and end-of-life decisions. Aims: The objective of this study is firstly to investigate the perception that doctors, nurses and psychologists, operating in Italian pediatric hospices, have of the appropriateness of the care they provide. Secondly, to understand what repercussions the perception of non-appropriateness has at individual and team level. Methods: A qualitative study was conducted between 2019 and 2020 through semi-structured interviews with a convenience sample of 17 professionals working it Italian pediatric hospices. Results: The interviewees do not refer to a common concept of appropriateness, but compare the latter to: the quality of life, the global care of the assisted person, the proportionality of care, the early recognition of the need for palliative care. The discussion within the team emerges as a privileged place to manage the discomfort of individual professionals in the face of treatment choices in conflict with their own values. Conclusion: the non-referring to a univocal conception of appropriateness deprives professionals of an objective criterion to resolve the most difficult decisions. However, it allows them to establish what from time to time seems to be the most appropriate care pathway for a given patient, at a given time and context, preserving the goal of personalized care.


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1. Buetow SA., Sibbald B., Cantrill JA., Halliwell S. Appropriateness in health care: application to prescribing. Soc Sci Med 1997; 45(2): 261-271.
2. Rodella S., Botturi D. (eds). Appropriatezza. Una guida pratica. Roma: Il Pensiero Scientifico Editore 2014.
3. Vasselli S., Filippetti G., Spizzichino L. Misurare la performance del sistema sanitario. Proposta di una metodologia. Roma: Il Pensiero Scientifico Editore 2005.
4. Benini F. (ed). Il Core Curriculum in Terapia del Dolore e Cure Palliative Pediatriche – Il lavoro in équipe. Milano: SICP 2014.
5. Pellegatta F., De Zen L., Lazzarin P., Jankovic M., Bertolotti M., Manfredini L., Aprea A., Benini F. The definition of eligibility criteria to paediatric palliative care. Medico e Bambino 2016; 35: 573-578.
6. De Tommasi V., Minetto M. La morte del bambino e la gestione del lutto: problemi sommersi che mettono in crisi. AreaPed 2016; 17(3): 117-121.
7. Benini F., Gangemi M. Cure palliative pediatriche: perché occuparsene. Quaderni ACP 2011; 18(5): 216-220.
8. Lotz JD., Jox RJ., Borasio GD., Fuhrer M. Pediatric advance care planning from the perspective of health care professionals: a qualitative interview study. Palliat Med 2015; 29(3): 212-222.
9. Sanmartin C., Murphy K., Choptain N., Conner-Spady B., McLaren L., Bohm E., Dunbar J.M., Sanmugasunderam S., De Coster C., McGurran J., Lorenzetti D., Noseworthy T. Appropriateness of healthcare interventions: concepts and scoping of the published literature. Int J Technol Assess Health Care 2008; 24(3): 342-349.
10. Fitch K., Bernstein FJ., Aguilar MD., Burnand B., Lacalle JR., Lazaro P. The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica: Rand Corporation 2001.
11. Ministero della Salute. Dipartimento della Programmazione e dell’Ordinamento del Servizio Sanitario Nazionale. Manuale di formazione per il governo clinico: Appropriatezza. Roma: Ministero della Salute 2012.
12. Humphrey L., Schlegel A., Seabrook R., McClead R. Trigger Criteria to Increase Appropriate Palliative Care Consultation in the Neonatal Intensive Care Unit. Pediatr Qual Saf 2019; 4(1): 1-7.
13. De Boer J., Van Rosmalen J., Bakker AB., Van Dijk M Appropriateness of care and moral distress among neonatal intensive care unit staff: repeated measurement. Nurs Crit Care 2015; 1(3): 19-27.
14. Solomon MZ., Sellers DE., Heller KS., Dokken DL., Leventown M., Rushton C., Troug RD., Fleischmann AR. New and lingering controversies in pediatric end-of-life care. Pediatrics 2005; 116(4); 872–883.
15. Tomlinson D., Bartels U., Hendershot E., Maloney AM., Ethier MC., Sung L. Factors affecting treatment choices in paediatric palliative care: Comparing parents and health professionals. Eur J Cancer 2011; 47: 2182-2187.
16. De Souza LF., Misko MD., Silva L., Poles K., Dos Santos MR., Bousso RS. Dignified death for children: perceptions of nurses from an oncology unit. Rev Esc Enferm USP 2013; 47(1): 30-37.
17. Dionne JM., D’Agincourt-Canning L. Sustaining life or prolonging dying? Appropriate choice of conservative care for children in end-stage renal disease: an ethical framework. Pediatr Nephrol 2015; 30: 1761–1769.
18. Spruit JL., Bell CJ., Toly VB., Prince-Paul M. Knowledge, beliefs, and behaviors related to palliative care delivery among pediatric oncology health care providers. J Pediatr Oncol Nurs 2018; 35(4): 247-256.
19. Sharpe VA., Faden AI. Appropriateness in patient care: A new conceptual framework. Milbank Q. 1996; 74:115-138.
20. Morosini P., Perraro F. Enciclopedia del Miglioramento Continuo di Qualità in Sanità. 2ª edizione. Torino: Centro Scientifico Editore 2001.
21. Hopkins A. (ed). What Do We Mean by Appropriate Health Care?. Qual. Health Care 1993; 2: 415-422.
22. Zanetti M., Montaguti U., Ricciarelli G. Il Medico e il Management. Genova: Accademia Nazionale di Medicina 1996.
23. Anghelescu L., Knapp E., Johnson L.M., Baker J.N. The role of paediatric anesthesiologist in relieving suffering at the end of life: when palliative sedation appropriate in pediatrics?. Paediatr Anaesth 2017; 27: 442-445.
24. McConnell T., Scott D., Porter S. Healthcare staff ’s experience in providing end-of-life care to children: A mixed-method review. Palliat Med 2016; 30(10): 905-919.
25. Bergestraesser E., Inglin S., Abbruzzese R., Marfurt-Russenberger K., Hošek M., Hornung R. The needs of professionals in the palliative care of children and adolescents. Eur J Pediatr 2013; 172: 111–118.

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