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Int J Palliat Nurs. 2013 May;19(5):251-6.

Missed opportunities: a case study of barriers to the delivery of palliative care on neonatal intensive care units.

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  • 1Neonatal Unit, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London, England.


Despite clear guidance from the Royal College of Paediatrics and Child Heath and Together for Short Lives, among others, the delivery of palliative care remains inconsistent on neonatal intensive care units, with many infants receiving full intensive care measures until the final moments of their lives. This case study identifies barriers faced by members of the neonatal team: fear of respiratory depression surrounding opiate use at the end of life, conflict among members of the care team leading to moral distress, and inadequate training and support for staff, which can inhibit the full transition to a palliative care framework at the end of life. Recommendations from the literature are collated to address these barriers.Training programmes for staff covering the tenets of palliative care, including symptom management, analgesic use, and communication skills, as well as regular multidisciplinary forums and debriefings are necessary to improve the care provided to infants and their families where there is a palliative care need.

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