Table 2 Overview of included articles (n = 30) on physicians’ perspectives

Fauriel et al. (2004) [34]

France, Switzerland, Belgium, Luxembourg

To evaluate withdrawal of LST in all nephrology centres in French-speaking European countries

Explorative qualitative approach using semi-directed, face-to-face interviews;

Analysis done by two researchers independently

31 paediatric nephrologists involved in LST decisions

17 males; aged 33–61 years, mean 48.5 years; paediatric practice 3–34 years, mean 18.2 years

[50 children]

De Graves and Aranda (2005) [35]

Australia

To explore the challenges and complexities when caring for a child with cancer no longer responding to curative therapy, and identify what issues and dilemmas arise when cure is no longer an appropriate goal of treatment

Explorative qualitative approach using participatory group discussions and in-depth interviews;

Thematic analysis

6 haematology/oncology consultants

[5 registered nurses, 3 haematology/oncology social workers]

Fauriel et al. (2005) [36]

France, Switzerland, Belgium, Luxembourg.

To describe the criteria on which decisions to withhold or withdraw LST were based

Explorative qualitative approach using semi-directed, face-to-face interviews;

Analysis done by two researchers independently

46 paediatric nephrologists

30 males, 16 females; aged 33–68 years, mean 50.4 years

Carnevale et al. (2011) [37]

Italy

To describe how LST decisions are made for critically ill children; and how these decisional processes are experienced by physicians, nurses and parents

Explorative qualitative approach using focus group discussions;

Follow grounded theory;

Thematic analysis

16 physicians practicing in the care of critically ill children

10 males, 6 females; aged 30–57 years, median 42 years; paediatric practice 0.66–28 years, median 13 years

[26 nurses, 9 parents]

Carnevale et al. (2012) [38]

France, Canada

To examine how physicians and nurses make decisions about LST for critically ill children and corresponding ethical challenges

Explorative qualitative approach using focus group discussions;

Follow grounded theory;

Thematic analysis

21 physicians

11 males, 10 females; aged 29–58 years; paediatric practice 0.17–29 years

[24 nurses]

Meyer et al. (2012) [39]

United States

To explore how practitioners respond to the question ‘What would you do if this were your child?’

Explorative qualitative approach using descriptive interviews;

Thematic analysis

15 physicians

[8 nurses, 1 social worker, 1 physical therapist]

Michelson et al. (2013) [40]

United States

To describe issues important in PICU EOL care decision-making and identify possible methods for improving the decision-making process for parents

Retrospective qualitative approach using focus group discussion

13 physicians

[23 nurses, 6 social workers, 4 chaplains, 1 child-life specialist, 1 case manager, 18 parents]

Pye (2013) [41]

United Kingdom

To explore perceptions of doctors and nurses working in a pediatric oncology unit regarding experiences and feelings concerning moral distress

Explorative qualitative approach using descriptive phenomenology;

Follow Colaizzi descriptive framework;

Thematic analysis

4 physicians

[4 nurses]

Bartholdson et al. (2015) [42]

Sweden

To describe healthcare professionals’ experiences of ethical issues and ways to deal with these when caring for children with cancer

Explorative qualitative approach using open-ended questions;

Qualitative content analysis

15 physicians

[72 nurses]

Boss et al. (2015) [43]

United States

To explore pediatric clinicians’ experiences with LST prior to the MOLST mandate and to describe clinician and family concerns and preferences regarding pediatric MOLST

Explorative qualitative approach using focus group discussions;

Analysis done by two researchers independently

69 physicians

[27 nurses]h8

De Vos et al. (2015) [44]

The Netherlands

To answer the questions: How do physicians and parents

communicate about decisions to withhold or withdraw LST, and to what extent do parents share in the decision-making process?

Prospective explorative approach;

Qualitative and quantitative analysis

27 physicians

15 males, 12 females; paediatric practice, 12 were 0–5 years, 2 were 5–10 years, 13 were ≥ 10 years

[37 parents]

Forbat et al. (2015) [45]

United Kingdom

To explore health professionals and family experiences of conflict in pediatric services

Explorative qualitative approach using semi-structured interviews;

Thematic analysis

20 physicians

[10 nurses, 8 parents, 3 chaplains, 2 lawyers, 2 Patient Advice and Liaison Service, 1 hospice head of care]

Lotz et al. (2015) [46]

Germany

To investigate the attitudes, barriers, and benefits as well as requirements for pediatric ACP

Explorative qualitative approach using semi-structured interviews;

Content analysis

9 physicians

[6 nurses, 2 social professionals]

Mitchell & Dale (2015) [47]

United Kingdom

To investigate current practice in ACP and how this might be improved, by exploring the experiences and perceptions of senior PICU medical and nursing staff who are frequently involved in managing EOL care for children and young people

Explorative qualitative approach using semi-structured interviews;

Thematic content analysis

8 PICU consultants

[6 nurses]

Bartholdson et al. (2016) [48]

Sweden

To explore healthcare staff’s experiences of participating in ECR sessions in childhood cancer care

Explorative qualitative observations of ethics care reflection sessions and qualitative interviews;

Follow grounded theory

15 physicians in ECR session, 2 physicians in individual interviews

13 males, 2 female in ECR; 2 males in interviews

[18 nurses, 1 therapist, 1 psychologist in ECR session, 8 nurses in individual interviews]

Bateman et al. (2016) [49]

United States

To describe communication between physician and the actor parent of a standardized 8-year-old patient in respiratory distress who is nearing the EOL

Explorative qualitative approach using high-fidelity simulation;

Follow grounded theory;

Thematic analysis

13 paediatric emergency medicine and paediatric critical care fellows

8 males, 5 females

Lotz et al. (2016) [50]

Germany, Switzerland

To investigate which factors paediatricians apply in deciding about medical indication, and how they manage conflicts with parents

Explorative qualitative approach using low-structured and case-based focus group discussions;

Content analysis

17 experienced paediatricians

12 males, 5 females; mean age 44 years, mean practice experience 16 years

Zaal-Schuller et al. (2016) [51]

The Netherlands

To compare the experiences of parents and physicians who were involved in the EOL decision-making process of the same child with profound intellectual and multiple disabilities

Retrospective qualitative approach using semi-structured interviews;

Coding done by two researchers independently

11 physicians

2 males, 9 females; aged 40–60

[14 children, 17 parents]

Badarau et al. (2017) [52]

Switzerland, Romania

To explore views of parents and physicians on decision-making in paediatric oncology

Explorative qualitative approach using semi-structured interviews;

Thematic analysis

26 physicians

Aged 30–62

[37 parents]

Birchley et al. (2017) [53]

United Kingdom

To critically describe the way in which the best interests standard operates in PICU

Explorative qualitative approach using interviews;

Thematic analysis

10 physicians

[14 parents, 8 nurses, 7 clinical ethics committee]

Cicero-Oneto et al. (2017) [54]

Mexico

To explore in-depth the EOL decision-making process and to identify the ethical principles that guide decision-making

Explorative qualitative approach using semi-structured, in-depth interviews;

Thematic analysis

13 oncologists

5 males; aged 32–52; practical experience 1–20 years, median 7 years

[13 parents, 6 adolescents]

Odeniyi et al. (2017) [55]

United States

To identify oncologists’ and intensivists’ perceived barriers to, and resources for, communication with families of children with cancer, and how the oncologist-intensivist relationship impacts communication and initiation of goals of care discussions

Explorative qualitative approach using semi-structured interviews;

Thematic analysis

10 paediatric oncology and intensive care physicians

5 males

Richards et al. (2018) [56]

United States

To understand how critical care physicians balance and integrate the interests of the child and family in decisions about LST

Explorative qualitative approach using semi-structured interviews;

Thematic and content analysis

22 physicians

15 males, 7 females; work experience 10 have ≤5 years, 12 have ≥5 years

Needle et al. (2019) [57]

United States

To explore the perspectives of PICU and hematopoietic stem cell transplant healthcare professionals as related to informed decision making of adolescents and the value of advance directives in paediatric practice

Explorative qualitative approach using focus group discussions;

Content analysis

15 physicians

8 males; aged 29–62 years, mean 40 years; practice experience 1–31 years, mean 10 years

Sasazuki et al. (2019) [58]

Japan

To delineate the decision-making processes that paediatricians apply when treating children with life-threatening conditions and the psychosocial experience of paediatricians involved in such care

Explorative qualitative approach using semi-structured interviews;

Comprehensive qualitative and content analysis

15 paediatricians

14 males, 1 female; aged 30–54 years

Ekberg et al. (2020) [59]

Australia

To explore how discussions about deterioration are managed within actual paediatric palliative care consultations.

Explorative observative approach;

Follow grounded theory;

Conversation analysis

7 healthcare professionals

Jongaramraung et al. (2020) [60]

Thailand

To investigate EOL decisions for children in PICU

Explorative qualitative approach using in-depth interviews;

Follow naturalistic inquiry

2 physicians

[17 nurses]

Orkin et al. (2020) [61]

Canada

To develop an in-depth understanding of the ACP experience for children with medical complexity

Explorative qualitative approach using semi-structured interviews;

Content analysis

8 physicians

[14 mothers, 2 nurses, 1 social worker]

Fay et al. (2021) [62]

Mexico

To analyse the ways in which pediatric patients have agency in relation to their parents and palliative care professionals within the hospital setting, as well as the structural circumstances that constrain said agency

Explorative qualitative approach using semi-structured interviews;

Follow hospital ethnography;

Thematic analysis

1 general practitioner and 1 paediatrician

Pediatric experience, general practitioner 10 months, paediatrician 5 years

[2 psychologists]

Verberne et al. (2021) [63]

The Netherlands

To explore how parents and healthcare professionals currently anticipate the future of the child and family in paediatric palliative care

Explorative qualitative approach using semi-structured interviews;

Thematic analysis

20 physicians

[42 parents, 13 nurses, 1 psychologist, 1 child-life specialist]