Feasibility, Acceptability, and Education of Pediatric Oncology Providers Before and After an Embedded Pediatric Palliative Oncology Clinic

Abstract

PURPOSE: Most pediatric palliative care (PPC) education is trainee-directed, didactic, or simulation-based and therefore limited in scope, realism, and audience. We explored whether an embedded pediatric palliative oncology (PPO) clinic is associated with improved pediatric oncology provider palliative care comfort, knowledge, and attitudes toward PPC and if the model is feasible for both clinical care and education of providers of all levels. METHODS: Oncology providers (oncologists, advanced practice providers, and fellows) were enrolled in this study. Based on interaction with the PPO clinic, two cohorts were defined: PPO providers (n = 11, 37.9%) and non-PPO providers (n = 18, 62.1%). Providers in both groups responded to qualitative and quantitative questionnaires about the feasibility and acceptability of PPO clinic, their attitudes toward PPC, and knowledge and comfort in PPC concepts at baseline and 1 year. Descriptive statistics were performed; demographic and outcome variables across cohorts by PPO grouping and experience were compared. RESULTS: All 29 pediatric oncology providers reported acceptability of a PPO clinic and favorable attitudes about PPC. The most feasible clinic model was oncology followed by PPO visits. Non-PPO group and less experienced (≤ 10 years) providers had greater improvement in knowledge and comfort with PPC skills than PPO group or more experienced providers. Providers lacked comfort in non-pain symptom management skills. CONCLUSION: This embedded PPO clinic model was feasible, acceptable, and highly rated by responding oncology clinicians, but was insufficient as a sole method of educating multidisciplinary oncology providers. Methods of combining clinical and formal education are needed to impart sustained educational change.

Presuppositions, cost–benefit, collaboration, and competency impacts palliative care referral in paediatric oncology: a qualitative study

“…The research participants' suggestions were for palliative care staff to be part of the oncology team and be present during consultations, family conferences and oncology team meetings. Currently, studies on the effectiveness of embedded paediatric palliative care models are restricted to the United States [103][104][105]. The feasibility and effectiveness of the embedded palliative care model in the paediatric oncology setting internationally would need further evaluation.…”

Paediatric oncologists’ perspectives on Strategic solutions to develop Integrated Cancer Palliative Care: feedback intervention theory as an explanatory Framework

“…This argument is supported by evidence that suggests screening scales [18][19][20], referral criteria [21], care algorithms [22], standardising practices [23] and periodic audits [24] have the potential to enhance integrated paediatric palliative care. Three studies from the United States showed that embedding palliative care providers in paediatric oncology settings was feasible, acceptable, and improved child and family outcomes [25][26][27]. The presence of a palliative care team enabled paediatric oncology residents to acquire palliative care skills through imbibed learning [28].…”

Unfolding parental knowledge, attitudes, and beliefs toward palliative care for children with cancer

“…Such “stigma” about palliative care among patients and caregivers may have originated from HCPs’ misconceptions and persisted among caregivers despite their positive experience with an early palliative care intervention 78 . Emerging studies from the United States underline a favorable shift in attitude toward PPC among HCPs 38,79,80 . Yet, this shift is lagging behind in Eurasia 81 and the Middle East 82 …”

“…78 Emerging studies from the United States underline a favorable shift in attitude toward PPC among HCPs. 38,79,80 Yet, this shift is lagging behind in Eurasia 81 and the Middle East. 82 The study yielded unique results regarding significant associations of parents' attitude toward PPC.…”