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Palliative team involvement in end-of-life care for Jewish and Muslim children in Jerusalem: A unique clinical and cultural context

Published online by Cambridge University Press:  06 March 2023

Avram R. Shack Open the ORCID record for Avram R. Shack [Opens in a new window] ,
Iris Fried  and
Yael Siedner-Weintraub Open the ORCID record for Yael Siedner-Weintraub [Opens in a new window]
Avram R. Shack
Affiliation:
Pediatric Palliative Care Unit, Wilf Children’s Hospital, Shaare Zedek Medical Center, Jerusalem, Israel Departmet of Pediatrics, Wilf Children’s Hospital, Shaare Zedek Medical Center, Jerusalem, Israel
Iris Fried
Affiliation:
Pediatric Palliative Care Unit, Wilf Children’s Hospital, Shaare Zedek Medical Center, Jerusalem, Israel Pediatric Hemato-Oncology Unit, Wilf Children’s Hospital, Shaare Zedek Medical Center, Jerusalem, Israel
Yael Siedner-Weintraub*
Affiliation:
Pediatric Palliative Care Unit, Wilf Children’s Hospital, Shaare Zedek Medical Center, Jerusalem, Israel Pediatric Intensive Care Unit, Wilf Children’s Hospital, Shaare Zedek Medical Center, Jerusalem, Israel
*
Author for correspondence: Yael Siedner-Weintraub, Wilf Children’s Hospital, Shaare Zedek Medical Center, 12 Shmuel Beyth Street, Jerusalem 9103012, Israel. Email: weinyael@gmail.com
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Abstract

Objectives

Pediatric palliative care services improve the quality of life for children with life-limiting and life-threatening diseases, although little has been published about variation based on cultural and religious factors. This article sets out to describe clinical and cultural characteristics of pediatric end-of-life patients in a majority Jewish and Muslim country with religious and legal constraints around end-of-life care.

Methods

We conducted a retrospective chart review of 78 pediatric patients who died during a 5-year period and could potentially have utilized pediatric palliative care services.

Results

Patients reflected a range of primary diagnoses, most commonly oncologic diseases and multisystem genetic disorders. Patients followed by the pediatric palliative care team had less invasive therapies, more pain management and advance directives, and more psychosocial support. Patients from different cultural and religious backgrounds had similar levels of pediatric palliative care team follow-up but certain differences in end-of-life care.

Significance of results

In a culturally and religiously conservative context that poses constraints on decision-making around end-of-life care, pediatric palliative care services are a feasible and important means of maximizing symptom relief, as well as emotional and spiritual support, for children at the end of life and their families.

Keywords

Pediatric palliative careEnd-of-life careJewishMuslim
Type
Original Article
Information
Palliative & Supportive Care , Volume 22 , Issue 1 , February 2024 , pp. 163 - 168
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Copyright
© The Author(s), 2023. Published by Cambridge University Press.

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References

American Academy of Pediatrics (2013) Section on hospice and palliative medicine and committee on hospital care: Pediatric palliative care and hospice care commitments, guidelines, and recommendations. Pediatrics 132(5), 966–972. doi:10.1542/peds.2013-2731CrossRefGoogle Scholar
Ananth, P, Melvin, P, Feudtner, C, et al. (2015) Hospital use in the last year of life for children with life-threatening complex chronic conditions. Pediatrics 136(5 ), 938–946. doi:10.1542/peds.2015-0260CrossRefGoogle ScholarPubMed
Baeke, G, Wils, JP and Broeckaert, B (2011) “We are (not) the master of our body”: Elderly Jewish women’s attitudes towards euthanasia and assisted suicide. Ethnicity & Health 16(3), 259–278. doi:10.1080/13557858.2011.573538CrossRefGoogle ScholarPubMed
Bentur, N, Laron, M, Azoulay, D, et al. (2015) Palliative services in general hospitals and geriatric medical centers in Israel [in Hebrew]. https://brookdale-web.s3.amazonaws.com/uploads/2018/01/704-15_Report-Heb.pdf (accessed 17  June 2022).Google Scholar
Blinderman, C (2007) Jewish law and end-of-life decision making: A case report. The Journal of Clinical Ethics 18(4), 384–390. doi:10.1086/JCE200718413CrossRefGoogle ScholarPubMed
Chakraborty, R, El-Jawahri, AR, Litzow, MR, et al. (2017) A systematic review of religious beliefs about major end-of-life issues in the five major world religions. Palliative & Supportive Care 15(5), 609–622. doi:10.1017/S1478951516001061CrossRefGoogle ScholarPubMed
Choudry, M, Latif, A and Warburton, KG (2018) An overview of the spiritual importances of end-of-life care among the five major faiths of the United Kingdom. Clinical Medicine 18(1), 23–31. doi:10.7861/clinmedicine.18-1-23CrossRefGoogle ScholarPubMed
Curlin, FA, Chin, MH, Sellergren, SA, et al. (2006) The association of physicians’ religious characteristics with their attitudes and self-reported behaviors regarding religion and spirituality in the clinical encounter. Medical Care 44(5), 446–453. doi:10.1097/01.mlr.0000207434.12450.efCrossRefGoogle ScholarPubMed
Dabar, G, Akl, IB and Sader, M (2021) Physicians’ approach to end of life care: Comparison of two tertiary care university hospitals in Lebanon. BMC Medical Education 21(1), . doi:10.1186/s12909-021-03022-xCrossRefGoogle ScholarPubMed
Dreesens, D, Veul, L, Westermann, J, et al. (2019) The clinical practice guideline palliative care for children and other strategies to enhance shared decision-making in pediatric palliative care; pediatricians’ critical reflections. BMC Pediatrics 19(1), . doi:10.1186/s12887-019-1849-0CrossRefGoogle ScholarPubMed
Eltaybani, S, Igarashi, A and Yamamoto-Mitani, N (2020) Palliative and end-of-life care in Egypt: Overview and recommendations for improvement. International Journal of Palliative Nursing 26(6), 284–291. doi:10.12968/ijpn.2020.26.6.284CrossRefGoogle ScholarPubMed
Feudtner, C, DiGiuseppe, DL and Neff, JM (2003) Hospital care for children and young adults in the last year of life: A population-based study. BMC Medicine 1, . doi:10.1186/1741-7015-1-3CrossRefGoogle Scholar
Feudtner, C, Kang, TI, Hexem, KR, et al. (2011) Pediatric palliative care patients: A prospective multicenter cohort study. Pediatrics 127(6), 1094–1101. doi:10.1542/peds.2010-3225CrossRefGoogle ScholarPubMed
Gibson-Smith, D, Jarvis, SW and Fraser, LK (2020) Place of death of children and young adults with a life-limiting condition in England: A retrospective cohort study. Archives of Disease in Childhood 106(8), 780–785. doi:10.1136/archdischild-2020-319700CrossRefGoogle Scholar
Golan, H, Bierlorai, B, Grebler, D, et al. (2008) Integration of a palliative and terminal care center into a comprehensive Pediatric Oncology Department. Pediatric Blood & Cancer 50, 949–955. doi:10.1002/pbc.21476CrossRefGoogle ScholarPubMed
Gustafson, C and Lazenby, M (2019) Assessing the unique experiences and needs of Muslim oncology patients receiving palliative and end-of-life care: An integrative review. Journal of Palliative Care 34(1), 52–61. doi:10.1177/0825859718800496CrossRefGoogle ScholarPubMed
Håkanson, C, Öhlén, J, Kreicbergs, U, et al. (2017) Place of death of children with complex chronic conditions: Cross-national study of 11 countries. European Journal of Pediatrics 176(3), 327–335. doi:10.1007/s00431-016-2837-0CrossRefGoogle ScholarPubMed
Hoell, JI, Weber, H, Warfsmann, J, et al. (2019) Facing the large variety of life-limiting conditions in children. European Journal of Pediatrics 178(12), 1893–1902. doi:10.1007/s00431-019-03467-9CrossRefGoogle ScholarPubMed
Israel Central Bureau of Statistics (2017) Deaths and mortality rates by age, sex, population group and religion [in Hebrew]. https://www.cbs.gov.il/he/publications/doclib/2019/3.shnatonhealth/st03_08.pdf (accessed 17  June 2022).Google Scholar
Israel Central Bureau of Statistics (2018) The face of society in Israel: Religion and self identification of level of religiousness [in Hebrew]. https://www.cbs.gov.il/he/publications/DocLib/2018/rep_10/h_print.pdf (accessed 17  June 2022).Google Scholar
Kaye, D (2009) End of life issues in Halacha. ASSIA: Jewish Medical Ethics 7(1), 31–40.Google Scholar
Kinzbrunner, BM (2004) Jewish medical ethics and end-of-life care. Journal of Palliative Medicine 7(4), 558–573. doi:10.1089/jpm.2004.7.558CrossRefGoogle ScholarPubMed
Laronne, A, Granek, L, Wiener, L, et al. (2021a) Oncologist conceptualizations of pediatric palliative care: Challenges and definitions. Supportive Care in Cancer 29(7), 3981–3989. doi:10.1007/s00520-020-05959-zCrossRefGoogle ScholarPubMed
Laronne, A, Granek, L, Wiener, L, et al. (2021b) Organizational and individual barriers and facilitators to the integration of pediatric palliative care for children: A grounded theory study. Palliative Medicine 35(8), 1612–1624. doi:10.1177/02692163211026171CrossRefGoogle Scholar
Leong, M, Olnick, S, Akmal, T, et al. (2016) How Islam influences end-of-life care: Education for palliative care clinicians. Journal of Pain and Symptom Management 52(6), . doi:10.1016/j.jpainsymman.2016.05.034CrossRefGoogle ScholarPubMed
Leshem, Z (2009) Authority and autonomy in Pesikat Halacha – Kislev, 5763. https://web.archive.org/web/20090220132007/http://www.nishmat.net/article.php?id=180&heading=0 (accessed 11  December 2022).Google Scholar
Loike, J, Gillick, M, Mayer, S, et al. (2010) The critical role of religion: Caring for the dying patient from an Orthodox Jewish perspective. Journal of Palliative Medicine 13(10), 1267–1271. doi:10.1089/jpm.2010.0088CrossRefGoogle ScholarPubMed
Muishout, G, van Laarhoven, HWM, Wiegers, G, et al. (2018) Muslim physicians and palliative care: Attitudes towards the use of palliative sedation. Supportive Care in Cancer 26(11), 3701–3710. doi:10.1007/s00520-018-4229-7CrossRefGoogle ScholarPubMed
Ntantana, A, Matamis, D, Savvidou, S, et al. (2017) The impact of healthcare professionals’ personality and religious beliefs on the decisions to forego life sustaining treatments: An observational, multicentre, cross-sectional study in Greek intensive care units. BMJ Open 7(7), . doi:10.1136/bmjopen-2016-013916CrossRefGoogle ScholarPubMed
Shaulov, A, Baddarni, K, Cherny, N, et al. (2019) “Death is inevitable – A bad death is not” report from an international workshop. Israel Journal of Health Policy Research 8(1), . doi:10.1186/s13584-019-0348-yCrossRefGoogle ScholarPubMed
Silbermann, M, Arnaout, M, Sayed, HAR, et al. (2012) Pediatric palliative care in the Middle East. In Knapp, C, Fowler-Kerry, S and Madden, V (eds), Pediatric Palliative Care: Global Perspectives. London: Springer, 127–159.CrossRefGoogle Scholar
Soudry, E, Sprung, CL, Levin, PD, et al. (2003) Forgoing life-sustaining treatments: Comparison of attitudes between Israeli and North American intensive care healthcare professionals. The Israel Medical Association Journal: IMAJ 5(11), 770–774.Google ScholarPubMed
Steinberg, A and Sprung, CL (2007) The dying patient act, 2005: Israeli innovative legislation. The Israel Medical Association Journal: IMAJ 9(7), 550–552.Google ScholarPubMed
Streuli, JC, Widger, K, Medeiros, C, et al. (2019) Impact of specialized pediatric palliative care programs on communication and decision-making. Patient Education and Counseling 102(8), 1404–1412. doi:10.1016/j.pec.2019.02.011CrossRefGoogle ScholarPubMed
Weiss, R (2022) Haredim (Charedim) or ultra-orthodox Jews. https://www.myjewishlearning.com/article/haredim-charedim/ (accessed 11  December 2022).Google Scholar
Wenger, NS and Carmel, S (2004) Physicians’ religiosity and end-of-life care attitudes and behaviors. The Mount Sinai Journal of Medicine, New York 71(5), 335–343.Google ScholarPubMed
Wiener, L, McConnell, DG, Latella, L, et al. (2013) Cultural and religious considerations in pediatric palliative care. Palliative & Supportive Care 11(1), 47–67. doi:10.1017/S1478951511001027CrossRefGoogle ScholarPubMed
World Health Organization (1998) Cancer pain relief and palliative care in children. https://apps.who.int/iris/handle/10665/42001 (accessed 17 June 2022).Google Scholar
Yaniv, O, Haddad, N and Assaf-Shapira, Y (2022) Jerusalem: Facts and trends 2022. Jerusalem Institute for Policy Research. Pub No. 586.Google Scholar