Initiation of paediatric advance care planning: Cross-sectional survey of health professionals reported behaviour.

The sample was self-selected and drawn from members of specific palliative care organizations, meaning the views may not represent less experienced practitioners or those outside these professional networks. Data were self-reported, which limits generalizability and accuracy compared to observed clinical behaviour. There were no data from non-responders, so it is unknown if those who did not participate have different practices or barriers. The qualitative analysis was limited to categorizing responses into pre-existing groups rather than exploring new themes in depth.

The study was funded by the UK Department of Employment and Learning as part of the lead author's PhD. The authors declared no competing interests.

Do not interpret the high confidence and positive attitudes towards pACP reported by these experienced professionals as evidence that initiation happens early or systematically. The data shows that despite this confidence, most clinicians still delay conversations until a child's health deteriorates and lack the tools or protocols to initiate earlier.