The rising prevalence of children with complex or life-limiting conditions has made advance care planning (ACP) an essential aspect of pediatric healthcare. In South Korea, discussions about withdrawing life-sustaining treatment were once avoided because such actions were historically penalized by law, fostering a culture of aggressive medical intervention. With evolving social attitudes toward end-of-life care, new legislation now safeguards patient dignity by emphasizing autonomy and supporting ACP practices. Nevertheless, little is known about how pediatricians currently perceive and implement ACP in Korea. This study sought to investigate pediatricians’ views on ACP and examine variations across different pediatric subspecialties. A cross-sectional, web-based survey was conducted among pediatricians caring for children with serious or life-limiting illnesses in 2018. Participants completed a self-administered questionnaire assessing their experiences and attitudes toward ACP. Of 96 respondents, 89 were eligible for analysis. When presented with a hypothetical clinical scenario, hemato-oncologists and intensivists were more inclined than neonatologists and neurologists to prioritize comfort care over aggressive treatment. While 72.2% of hemato-oncologists reported that they frequently discuss ACP with parents, more than half of other pediatricians indicated they rarely engage in such conversations. Moreover, 65% of all respondents stated that they never initiate ACP discussions with adolescent patients, with minimal variation between specialties. The most commonly identified barriers to ACP were insufficient institutional support following ACP implementation (82.0%) and ambiguity regarding legal accountability (70.8%). Pediatricians’ perspectives and experiences with advance care planning differ notably among subspecialties. To facilitate more effective communication about prognosis and care preferences, comprehensive institutional frameworks and professional education are needed to help clinicians involve both children and families in ACP discussions.
