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Neonatal Palliative Care: Developing Consensus Among Neonatologists Using the Delphi Technique in Portugal

Mendes, Joana C. C. PhD, MSN, RN; Justo da Silva, Lincoln PhD, MD

Section Editor(s): Catlin, Anita

doi: 10.1097/ANC.0000000000000037
Ethical Issues in Newborn Care

Pediatric palliative care in Portugal is improving, but there is still additional work to do concerning programs or guidelines for this subject. In Portugal, physicians are the stakeholders in the decision-making process with reference to the transition to palliative care in the neonatal intensive care unit, and it was considered very important to raise their awareness and motivation about neonatal palliative care. Our research was based on Catlin and Carter's protocol from 2002 and the main goal was to assess neonatologists' willingness to build a palliative care and end-of-life protocol that could be acceptable nationwide. The survey used the Delphi technique and was developed in 3 rounds. The expert panel was composed of 57 participants who represented 41% of the Portuguese neonatologists. The study was conducted via the Internet, based in a researcher-created private Web site, and e-mail was used for data collection and feedback. Neonatologists agreed on 7 areas: (1) planning (medical education, resources, and local), (2) prenatal palliative care, (3) neonatal palliative care criteria, (4) the parents (presenting neonatal palliative care to parents, including then in the daily care of newborns and in family-centered care), (5) physicians' needs, (6) pain and symptom management, and (7) end-of-life care (withholding/withdrawing ventilation and hydration/nutrition).

Bioethics Institute of Portuguese Catholic University (Dr Mendes) and School of Medicine, University of Lisbon, Santa Maria Hospital (Dr da Silva), Portugal.

Correspondence: Joana C. C. Mendes, PhD, MSN, RN, Neonatal Intensive Care Unit, São Francisco Xavier Hospital, CHLO EPE, Lisbon, Portugal (

The authors declare no conflict of interest.

© 2013 by The National Association of Neonatal Nurses