Take free quizzes online at acsjournals.com/ce ONLINE CONTINUING EDUCATION ACTIVITYAfter reading the article "Pediatric Palliative Care in the Community" the learner should be able to: 1. Describe the scope of pediatric palliative care and community-based pediatric palliative care. 2. Review the indications for referral of children with cancer to pediatric palliative care and community-based pediatric palliative care. 3. Discuss the benefits of and barriers to referral of children with cancer to pediatric palliative care and community-based pediatric palliative care. ARTICLE TITLE: Pediatric Palliative Care in the Community CONTINUING MEDICAL EDUCATION ACCREDITATION AND DESIGNATION STATEMENT:Blackwell Futura Media Services is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians.Blackwell Futura Media Services designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit™. Physicians s hould only claim credit commensurate with the extent of their participation in the activity. CONTINUING NURSING EDUCATION ACCREDITATION AND DESIGNATION STATEMENT:The American Cancer Society (ACS) is accredited as a provider of continuing nursing education (CNE) by the American Nurses Credentialing Center's Commission on Accreditation.Accredited status does not imply endorsement by the ACS or the American Nurses Credentialing Center of any commercial products displayed or discussed in conjunction with an educational activity. The ACS gratefully acknowledges the sponsorship provided by Wiley for hosting these CNE activities. EDUCATIONAL OBJECTIVES: ACTIVITY DISCLOSURESThis work was supported by the American Lebanese Syrian Associated Charities (ALSAC). ACS CONTINUING PROFESSIONAL EDUCATION COMMITTEE DISCLOSURESEditor, Director of Continuing Professional Education, and ACS Director of Medical Content Ted Gansler, MD, MBA, MPH, has no financial relationships or interests to disclose. Deputy Editor and ACS Director of Prostate and Colorectal CancersDurado Brooks, MD, MPH, has no financial relationships or interests to disclose. Lead Nursing and Associate Editor Marcia Grant, RN, PhD, FAAN, has no financial relationships or interests to disclose. Associate Editor and Chief Cancer Control Officer Richard C. Wender, MD, has no financial relationships or interests to disclose. AUTHOR DISCLOSURESErica C. Kaye, MD, Jared Rubenstein, MD, Deena Levine, MD, Justin N. Baker, MD, Devon Dabbs, BBA, and Sarah E. Friebert, MD have no financial relationships or interests to disclose.CNE CME SCORING A score of 70% or better is needed to pass a quiz containing 10 questions (7 correct answers), or 80% or better for 5 questions (4 correct answers). INSTRUCTIONS ON RECEIVING CME CREDITThis activity is intended for physicians. For information concerning the applicability and acceptance of CME credit for this activity, please consult your professional licensing board.This activity is designed to be completed within 1.5 hours; physicians should claim only those...
Objective: To report our first case series of Dignity Therapy modified for a pediatric palliative care population. Background: Dignity Therapy has been utilized successfully with terminally ill adult patients to help restore a sense of dignity and personhood as well as cope with existential distress near the end of life. To our knowledge, there are no published reports of this treatment modality in pediatric patients. Methods: The authors report the experience of a single-center case series of Dignity Therapy in a pediatric palliative care population. The adult Dignity Therapy process was adapted to fit the pediatric population and their families. Modifications are explained in some detail, and specific cases are shared to illustrate the process. The goal of this case series is to report on the application of Dignity Therapy to the pediatric population. Setting/subjects: Inclusion criteria for the cases series consisted of children and their families who were aware that death may occur soon, were English speaking, admitted to the hospital, and receiving care from the palliative care service. Results: Eight patients or their caregivers have completed Dignity Therapy thus far through our program. Four consented to publication of their experience. Three patients were adolescents and told their own story and the story of one younger nonverbal child was told by her family. All four participants reported that the intervention was acceptable and expressed gratitude for their final generativity document. No patient or family reported distress or negative effects from participation in Dignity Therapy. Conclusions: This case series describes how Dignity Therapy is possible with adaptations in the pediatric population, and how Dignity Therapy by proxy may be possible for caregivers of patients unable to tell their own story.
To complete the curriculum, learners rotating through a pediatric palliative care service are asked to submit a piece of reflective writing. Here, we share an edited version of the narrative one student submitted, accompanied by a brief consideration of the numerous benefits of reflective writing for medical trainees (including improved communication and professionalism skills, as well as increased levels of empathy and comfort when facing complex or difficult situations). Additionally, we describe how brief personal narratives may serve to reduce common misconceptions and confusion by educating patients, families, and clinicians about the reality and the role of pediatric palliative care.
Problem Microaggressions are pervasive in daily life, including in undergraduate and graduate medical education and across health care settings. The authors created a response framework (i.e., a series of algorithms) to help bystanders (i.e., health care team members) become upstanders when witnessing discrimination by the patient or patient’s family toward colleagues at the bedside during patient care, Texas Children’s Hospital, August 2020 to December 2021. Approach Similar to a medical “code blue,” microaggressions in the context of patient care are foreseeable yet unpredictable, emotionally jarring, and often high-stakes. Modeled after algorithms for medical resuscitations, the authors used existing literature to create a series of algorithms, called Discrimination 911, to teach individuals how to intervene as an upstander when witnessing instances of discrimination. The algorithms “diagnose” the discriminatory act, provide a process to respond with scripted language, and subsequently support a colleague who was targeted. The algorithms are accompanied by training on communication skills and diversity, equity, and inclusion principles via a 3-hour workshop that includes didactics and iterative role play. The algorithms were designed in the summer of 2020 and refined through pilot workshops throughout 2021. Outcomes As of August 2022, 5 workshops have been conducted with 91 participants who also completed the post-workshop survey. Eighty (88%) participants reported witnessing discrimination from a patient or patient’s family toward a health care professional, and 89 (98%) participants stated that they would use this training to make changes in their practice. Next Steps The next phase of the project will involve continued dissemination of the workshop and algorithms as well as developing a plan to obtain follow-up data in an incremental fashion to assess for behavior change. To reach this goal, the authors have considered changing the format of the training and are planning to train additional facilitators.
A 2-year-old female presents for evaluation of 4 weeks of daily fevers. When the fevers began, she had mild upper respiratory tract symptoms, which quickly resolved. The fevers persisted, however, with a maximum of 40°C. The child's review of symptoms was significant for a 1-kg weight loss over the past month. Ten months before presentation, she had moved from Saudi Arabia with her family. One week before the onset of symptoms, she had visited a petting zoo. During episodes of fever, the patient was ill-appearing and had an elevated heart rate and respiratory rate. On examination, she was found to be thin, febrile, tachycardic, and with scattered lymphadenopathy. Results of laboratory tests were remarkable for an elevated white blood cell count of 16 100 cells per uL with a neutrophilic predominance. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated at 99 mm/h and 27 mg/dL, respectively. A chest radiograph indicated a small amount of fluid in the interlobar fissures. Our expert panel examines her case, offers a definition of fever of unknown origin, and makes diagnostic considerations. CASE HISTORY WITH SUBSPECIALTY INPUTJohn Darby, MD, Moderator, Pediatric Hospital Medicine:A 2-year-old girl was transferred for evaluation and management of fevers. She was well until 4 weeks before admission, when she developed symptoms of an upper respiratory tract infection (URTI) and intermittent fevers up to 40°C. Although the URTI symptoms resolved over 3 days, the patient continued to have daily fever spikes for the next 4 weeks. When febrile, she was ill-appearing, tachypneic, and tachycardic, but between fever spikes, she was a normal 2-year-old playing with her siblings. She had been evaluated in outpatient settings several times over the past month, with no definitive diagnosis, and had received ceftriaxone and clindamycin for unclear reasons, with no improvement in symptoms. Her parents initially attributed the fevers to a viral illness she acquired from day care.Review of systems was remarkable for weight loss of 1 kg (according to parental report) and poor appetite. Her medical history was unremarkable, and her immunizations were up to date through 1 year.The child was born in Toronto but lived in Saudi Arabia until 10 months before the onset of symptoms, when the family moved to Toronto. She then moved to Texas with her parents and younger siblings 1 month before presentation. The child attends day care and had visited a petting zoo ∼1 week before the symptoms began. Although she had a negative reaction to purified protein derivative (PPD) after her time in Saudi Arabia, her parents have never been tested for tuberculosis (TB). Dr Darby contributed to the design and execution of the case conference, drafted and edited the original manuscript, and made revisions to the manuscript; and Ms Liddell and Drs DeGuzman, McClain, Rubenstein, Chase, and Marquez contributed to the design and execution of the case conference, and reviewed and made revisions to the manuscript. All authors ...
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