@article{2987413,
    title = "Physicians’ attitudes in relation to end-of-life decisions in Neonatal Intensive Care Units: a national multicenter survey",
    author = "Chatziioannidis, I. and Iliodromiti, Z. and Boutsikou, T. and Pouliakis, A. and Giougi, E. and Sokou, R. and Vidalis, T. and Xanthos, T. and Marina, C. and Iacovidou, N.",
    journal = "BMC Medical Ethics",
    year = "2020",
    volume = "21",
    number = "1",
    publisher = "BioMed Central Ltd.",
    issn = "1472-6939",
    doi = "10.1186/s12910-020-00555-6",
    keywords = "article;  artificial ventilation;  attitude;  controlled study;  demography;  female;  Greece;  human;  human experiment;  male;  multicenter study;  neonatal intensive care unit;  neonatologist;  newborn;  prognosis;  quality of life;  religion;  socioeconomics;  structured questionnaire;  terminal care;  treatment withdrawal;  clinical trial;  death;  decision making;  health personnel attitude;  intensive care unit;  neonatal intensive care unit;  physician;  questionnaire;  treatment withdrawal, Attitude of Health Personnel;  Death;  Decision Making;  Humans;  Infant, Newborn;  Intensive Care Units;  Intensive Care Units, Neonatal;  Physicians;  Quality of Life;  Surveys and Questionnaires;  Terminal Care;  Withholding Treatment",
    abstract = "Background: End-of-life decisions for neonates with adverse prognosis are controversial and raise ethical and legal issues. In Greece, data on physicians’ profiles, motivation, values and attitudes underlying such decisions and the correlation with their background are scarce. The aim was to investigate neonatologists' attitudes in Neonatal Intensive Care Units and correlate them with self-reported practices of end-of-life decisions and with their background data. Methods: A structured questionnaire was distributed to all 28 Neonatal Intensive Care Units in Greece. One hundred and sixty two out of 260 eligible physicians answered anonymously the questionnaire (response rate 66%). Demographic and professional characteristics, self-reported practices and opinions were included in the questionnaire, along with a questionnaire of 12 items measuring physicians’ attitude and views ranging from value of life to quality of life approach (scale 1–5). Results: Continuation of treatment in neonates with adverse prognosis without adding further therapeutic interventions was the most commonly reported EoL practice, when compared to withdrawal of mechanical ventilation. Physicians with a high attitude score (indicative of value of quality-of-life) were more likely to limit, while those with a low score (indicative of value of sanctity-of-life) were more likely for continuation of intensive care. Physicians’ educational level (p:0.097), involvement in research (p:0.093), religion (p:0.024) and position on the existing legal framework (p < 0.001) were factors that affected the attitude score. Conclusions: Physicians presented with varying end-of-life practices. Limiting interventions in neonates with poor prognosis was strongly related to their attitudes. The most important predictors for physicians' attitudes were religiousness and belief for Greek legal system reform. © 2020, The Author(s)."
}