Factors Associated With Knowledge and Comfort Providing Palliative Care: A Survey of Pediatricians in Mexico

Abstract

Background: Lack of education and training in palliative care has been described to be one of the most important barriers to pediatric palliative care implementation. Objective: To examine what factors determine the degree of knowledge and level of comfort Mexican pediatricians have providing pediatric palliative care. Methods: A questionnaire that assessed palliative care concepts was developed and applied online to Mexican pediatricians, both generalists and specialists. Results: A total of 242 pediatricians responded. The majority had not received palliative care education (92.6%) and felt uncomfortable discussing palliative needs with patients and families (92.1%). The mean score of the questionnaire was 6.8 (+1.4) of 10 correct answers. Knowledge in palliative care was associated with exposure to oncologic patients (P ¼ .01) and previous palliative care education (P ¼ .02) but inversely related to the pediatrician's age (P ¼ .01). Comfort addressing patient's palliative care needs was associated with knowledge in palliative care (P < .01), exposure to oncologic patients (P ¼ .03), and previous education in palliative care (P ¼ .02). Conclusions: Although Mexican pediatricians have basic knowledge of palliative care concepts, they do not feel comfortable addressing palliative care needs, suggesting that the main barrier for implementing palliative care is not the lack of knowledge but rather feeling uncomfortable when addressing these issues with patients and families. Educational programs should incorporate strategies that could help physicians develop comfort in approaching palliative care patients.

A multicountry assessment in Eurasia: Alignment of physician perspectives on palliative care integration in pediatric oncology with World Health Organization guidelines

“…There are limited data on physician knowledge of palliative care in other resource-limited settings; however, these results are comparable to previous results finding that physicians had a mean score of 68%. 28 Respondent alignment with WHO guidance on palliative care integration varied greatly in our study both among individual participants (7%-100%) and by country (62%-81%). In a multiple regression analysis, independent predictors of higher WHO alignment included previous palliative care education, more experience with patient death, and country of practice.…”

“…Although those with palliative education felt less burdened, they did not report higher confidence in providing elements of palliative care, and this differs from the effects of palliative care education in other low-income settings. 28 This study clearly captures low exposure to formal palliative care training among physicians caring for children with cancer in Eurasia (19%), with the majority of the respondents (81%) having no prior palliative care education. This represents an urgent need to increase access to palliative care training for physicians treating children with cancer in the region.…”

Barriers to the early integration of palliative care in pediatric oncology in 11 Eurasian countries

“…These findings align with published data from other resource-limited settings that attributed delayed palliative care to physician attitudes, discomfort, and the need to control patient care. 13,14,27 However, contrary to physician perceptions of family unreadiness and resistance to palliative care consultation, children with cancer and their parents value and express interest in the early integration of palliative care in high-resource settings. 28 The limited data available from LMICs have illustrated that although parents resisted direct communication between the pediatric palliative care team and the patient, they valued increased information, communication, social support, and adequate pain management.…”

“…These findings are corroborated by studies in other resource-limited settings in which financial and structural barriers drive lack of access compared to high-income countries in which family and physician attitudes are identified as primary barriers. 9,10,14,22 In 2009, Lynch et al identified similar barriers to palliative care delivery in Eurasia such as limited access to specialists and stringent federal support, revealing a disappointing lack of regional progress over the past decade to increase the availability of palliative care services, particularly in childhood cancer care. 16 These results highlight the significance of structural barriers to palliative care integration in resource-limited settings and emphasize the importance of raising awareness and empowering local governments to support health care system infrastructure and increase hospital capacity.…”

“…Provider fears or misperceptions often result in the late integration of palliative care after curative options are no longer available 7,13 . However, LMICs face an additional set of challenges to integrating palliative care into disease‐directed treatment, encompassing structural barriers such as limited financial resources, health system infrastructure and capacity, and medical education for specialists and general providers 14‐17 …”