Impact of Pediatric Primary Palliative Care Education and Mentoring in Practice

Lafond, Deborah; Perko, Kathy; Fisher, Deborah; Mahmood, Laila; Hinds, Pamela S.

doi:10.1097/njh.0000000000000802

Cited by 9 publications

(12 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This intervention ensures that the patients' symptoms are still being managed while working to build capacity in subspecialty care. 20 Finally, although many similarities exist among countries and regions, differences remain, especially with regard to available resources. In Latin America, LMICs had higher mean scores than HICs in every barrier evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…Targeted educational interventions teaching general pediatricians the principles of primary palliative care would increase the knowledge among the physician population most likely to provide care for children with cancer. This intervention ensures that the patients’ symptoms are still being managed while working to build capacity in subspecialty care …”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14] When considering provision of PPC for children with cancer, it is important to differentiate between specialized and primary palliative care. 20 Specialty palliative care is the provision of palliative care to patients by professionals who have received additional training and work in conjunction with a patient's primary team. Primary palliative care can be provided by any health care professional and not those who received additional subspecialty training.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ideal vs Actual Timing of Palliative Care Integration for Children With Cancer in Latin America

et al. 2023

View full text Add to dashboard Cite

ImportanceEarly integration of pediatric palliative care (PPC) for children with cancer is critical for the quality of life of both patient and family. To improve access to PPC in resource-limited settings, barriers to early integration must be understood.ObjectivesTo evaluate the ideal vs actual timing of PPC integration for children with cancer and to uncover barriers to early integration identified by physicians in Latin America.Design, Setting, and ParticipantsThe Assessing Doctors’ Attitudes on Palliative Treatment (ADAPT) survey was distributed electronically from August 1, 2020, to January 31, 2021, to physicians who treat children with cancer in 17 countries in Latin America.Main Outcomes and MeasuresThe ADAPT survey queried for understanding of ideal vs actual timing of PPC for children with cancer and for identification of barriers to PPC integration. Descriptive statistics were used to summarize the data. For secondary analyses, a comparison of the associations of previous palliative care training with physician specialty was performed using the Pearson χ2 test or the Fisher exact test. The McNemar test was used to assess responses regarding the actual vs ideal timing of PPC consultation. Analysis of variance was used to compare mean values for perceived barriers by country income level. Answers to open-ended questions were analyzed qualitatively.ResultsA total of 831 physicians (578 women [69.6%]; 275 physicians [33.1%] aged &lt;35 years and 556 physicians [66.9%] aged ≥35 years) from 17 countries participated, with an overall response rate of 37.9% (831 of 2193) and a median country response rate of 51.4% (range, 22.2%-88.9%). Most respondents (572 [68.8%]) said that PPC should be involved from diagnosis, but only 117 (14.1%) stated that this occurred at their institution (P &lt; .001). The most significantly ranked barriers to PPC were lack of home-based services (713 [85.8%]), personnel (654 [78.7%]), and knowledge about PPC (693 [83.4%]), along with physician (676 [81.3%]) and family (603 [72.6%]) discomfort about PPC involvement. In addition, these barriers were rated as more important in lower-middle income countries compared with upper-middle income countries and high-income countries.Conclusions and RelevanceThis study highlights the discrepancy between ideal and actual timing of PPC for children with cancer and barriers to early PPC integration in Latin America. Interventions addressing access to PPC resources, didactic training, and clinical education (with a particular focus on equitable access to basic resources and support) are critical to improve the timing and quality of PPC in the region.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ideal vs Actual Timing of Palliative Care Integration for Children With Cancer in Latin America

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Programs on medical ethics and conflict negotiation, as well as communication skills building and peer-to-peer support workshops, have shown efficacy. [28][29][30] In the short term, when dealing with family objection to truth disclosure, medical trainees can be supported to report that if they are asked directly by the patient, they have an ethical obligation to respond without lying. This approach may help to alleviate some of the moral distress that comes with lying.…”

Section: Discussionmentioning

confidence: 99%

Truth Disclosure at the End of Life: A Qualitative Study of Internal Medicine Residents in the United Arab Emirates

Ibrahim

Harhara

2021

Am J Hosp Palliat Care

View full text Add to dashboard Cite

Background Respect for patient autonomy has become the guiding biomedical ethical tenet in the West; yet, moral values are contextual and culturally relevant. In the collectivist society of the Middle East, families and physicians have historically believed that concealing truth about a terminal illness is more ethical and compassionate. Recent studies reveal a trend toward truth disclosure. Objective To gain insight into resident experiences with, and barriers to, truth disclosure in terminally ill patients in the United Arab Emirates (UAE). Methods Focus group interviews were conducted with first through fourth year internal medicine residents and recent graduates at two large academic medical centers in the UAE. Qualitative thematic content analysis was used to identify themes related to communication and truth telling in end-of-life care. Results Residents revealed that non-disclosure of medical information in serious illness is a common practice in UAE hospitals. Barriers to truth telling include family objection, deficits in medical training, and inconsistently implemented institutional guidelines. Conclusion Educational and policy interventions are needed to improve physician-patient communication, decrease patient-family-physician tension, and alleviate trainee moral distress.

show abstract

“…Moreover, partenering with well established programs that provide palliative care education and mentoring opportunities to primary teams can strengthen both the confidence and competence in delivering PPC (eg, PANDA cubs Primary Palliative Care Program). 18 Virtual community such as the Project Extension for Community Healthcare Outcomes (Project ECHO®) can enhance the capabilities of primary teams. 19 PPC services can also be developed in the absence of a dedicated PPC physician.…”

Section: Myth 5: Providing Ppc Is Costly and Requires Specialized Res...mentioning

confidence: 99%

Addressing 10 Myths About Pediatric Palliative Care

Sadler

Khan

Alghamdi

et al. 2023

Am J Hosp Palliat Care

View full text Add to dashboard Cite

With advances in biomedical sciences, a growing number of conditions affecting children have evolved from being considered life-limiting to almost chronic diseases. However, improvements in survival rates often come at a cost of increased medical complexity and lengthy hospitalizations, which can be associated with a poorer quality of life. This is where pediatric palliative care (PPC) can play a significant role. PPC is a specialty of healthcare that focuses on the prevention and relief of suffering in children with serious conditions. Unfortunately, despite the well-identified need for PPC services across pediatric specialties, multiple misconceptions persist. Common myths about palliative care are identified and deconstructed in light of the most recent evidenced-based references in the field to provide guidance to healthcare providers to address these. PPC is often associated with end-of-life care, loss of hope, and cancer. Some healthcare providers and parents also believe that information like diagnosis should be withheld from children for their emotional protection. These examples of misconceptions hinder the integration of pediatric palliative care and its additional layer of support and clinical expertise. PPC providers have advanced communication skills, are able to instill hope in the face of uncertainty, are trained to initiate and implement individualized pain and symptom management plans, and understand how to improve the quality of life in children with serious illnesses. Improved awareness about the scope of PPC is needed to ensure that children benefit from the maximum expertise and support throughout their complex health trajectories.

show abstract

Impact of Pediatric Primary Palliative Care Education and Mentoring in Practice

Cited by 9 publications

References 21 publications

Ideal vs Actual Timing of Palliative Care Integration for Children With Cancer in Latin America

Ideal vs Actual Timing of Palliative Care Integration for Children With Cancer in Latin America

Truth Disclosure at the End of Life: A Qualitative Study of Internal Medicine Residents in the United Arab Emirates

Addressing 10 Myths About Pediatric Palliative Care

Contact Info

Product

Resources

About