Not Just Little Adults: Palliative Care Physician Attitudes Toward Pediatric Patients

Rapoport, Adam; Obwanga, Christopher; Sirianni, Giovanna; Librach, S. Lawrence; Husain, Amna

doi:10.1089/jpm.2012.0393

Cited by 16 publications

(22 citation statements)

References 15 publications

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“…34 Healthcare professionals reported having inadequate training, education or support to manage symptoms in children at end of life, and that they would value further training. [19][20][21]25,32,43,46,51,54,58,59,64,76 In one study, the barriers to obtaining the necessary education or training included a lack of opportunities, time and costs. 34 Fowler et al 36 found that healthcare professionals with formal training were more likely to feel comfortable treating pain and psychological issues.…”

Section: Barriers and Facilitators To Symptom Management Reported By mentioning

confidence: 99%

A mixed-methods systematic review and meta-analysis of barriers and facilitators to paediatric symptom management at end of life

et al. 2020

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Background: Symptom management for infants, children and young people at end of life is complex and challenging due to the range of conditions and differing care needs of individuals of different ages. A greater understanding of these challenges could inform the development of effective interventions. Aim: To investigate the barriers and facilitators experienced by patients, carers and healthcare professionals managing symptoms in infants, children and young people at end of life. Design: A mixed-methods systematic review and meta-analysis was undertaken (PROSPERO ID: CRD42019124797). Data sources: The Cochrane Library, PROSPERO, CINAHL, MEDLINE, PsycINFO, Web of Science Core Collection, ProQuest Dissertations & Theses Database, Evidence Search and OpenGrey were electronically searched from the inception of each database for qualitative, quantitative or mixed-methods studies that included data from patients, carers or healthcare professionals referring to barriers or facilitators to paediatric end-of-life symptom management. Studies underwent data extraction, quality appraisal, narrative thematic synthesis and meta-analysis. Results: A total of 64 studies were included (32 quantitative, 18 qualitative and 14 mixed-methods) of medium-low quality. Themes were generated encompassing barriers/facilitators experienced by carers (treatment efficacy, treatment side effects, healthcare professionals’ attitudes, hospice care, home care, families’ symptom management strategies) and healthcare professionals (medicine access, treatment efficacy, healthcare professionals’ demographics, treatment side effects, specialist support, healthcare professionals’ training, health services delivery, home care). Only one study included patients’ views. Conclusion: There is a need for effective communication between healthcare professionals and families, more training for healthcare professionals, improved symptom management planning including anticipatory prescribing, and urgent attention paid to the patients’ perspective.

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Section: Barriers and Facilitators To Symptom Management Reported By mentioning

confidence: 99%

A mixed-methods systematic review and meta-analysis of barriers and facilitators to paediatric symptom management at end of life

et al. 2020

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“…In a survey of general palliative care providers, most described their pediatric training as inadequate, but they nonetheless provided palliative care for dying children. 19 Our study identified the theme of education across the priorities of decision making (Priority 3), care coordination (Priority 13), and symptom control (Priority 19). Quality palliative care training includes competencies in symptom assessment, pharmacologic and non-pharmacologic interventions, multidisciplinary team dynamics, decisional ethics, and communication skills.…”

Section: Discussionmentioning

confidence: 99%

Research Priorities in Pediatric Palliative Care

Baker

Levine

Hinds

et al. 2015

The Journal of Pediatrics

102

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Objective To synthesize the perspectives of a broad range of pediatric palliative care (PPC) clinicians and parents to formulate a consensus on the prioritization of the PPC research agenda. Study design A 4-round modified Delphi online survey was administered, to PPC experts and to parents of children who had received PPC. In Round 1, research priorities were spontaneously generated. Rounds 2 and 3 then served as convergence rounds to synthesize priorities. A fourth iteration asked participants to rank the research priorities that had reached at least 80% consensus. Results A total of 3093 concepts were spontaneously generated by 170 experts and 72 parents in Round 1 (65.8% response rate [RR]). These concepts were thematically organized into 78 priorities and recirculated for Round 2 ratings (n = 130, 53.7% RR). Round 3 achieved response stability, with 31 consensus priorities oscillating within 10% of the mode (n = 98, 75.4% RR). Round 4 resulted in consensus recognition of 20 research priorities, which were thematically grouped as decision making, care coordination, symptom management, quality improvement, and education. Conclusions This modified Delphi survey used professional and parental consensus to identify preeminent PPC research priorities. Attentiveness to these priorities may help direct resources and efforts toward building a formative evidence base. Investigating PPC implementation approaches and outcomes can help improve the quality of care services for children and families.

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“…In recent studies, physicians have reported a lack of comfort and confidence in providing pediatric palliative care, specifically as it pertains to psychosocial support. 57,58 PICU physicians reported that confidence and comfort increased as they practiced longer, but that the social and psychological needs of care remained areas that they did not feel as comfortable providing. 57 Palliative care physicians who provide support to pediatric patients indicated moderate to high levels of discomfort with ethical issues related to pediatric palliative care.…”

Section: Challenges To Providing High Quality Care To the Familymentioning

confidence: 99%

“…57 Palliative care physicians who provide support to pediatric patients indicated moderate to high levels of discomfort with ethical issues related to pediatric palliative care. 58 In general, physicians reported that their level of training was inadequate to prepare them for pediatric palliative care, especially as it relates to supporting families, talking with siblings, and participating in decision-making. 57,58 These findings highlight the importance of increased training and support for physicians in pediatric palliative care and interprofessional education.…”

Section: Challenges To Providing High Quality Care To the Familymentioning

confidence: 99%

The Duty of the Physician to Care for the Family in Pediatric Palliative Care: Context, Communication, and Caring

2014

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Pediatric palliative care physicians have an ethical duty to care for the families of children with life-threatening conditions through their illness and bereavement. This duty is predicated on 2 important factors: (1) best interest of the child and (2) nonabandonment. Children exist in the context of a family and therefore excellent care for the child must include attention to the needs of the family, including siblings. The principle of nonabandonment is an important one in pediatric palliative care, as many families report being well cared for during their child' s treatment, but feel as if the physicians and team members suddenly disappear after the death of the child. Family-centered care requires frequent, kind, and accurate communication with parents that leads to shared decision-making during treatment, care of parents and siblings during end-of-life, and assistance to the family in bereavement after death. Despite the challenges to this comprehensive care, physicians can support and be supported by their transdisciplinary palliative care team members in providing compassionate, ethical, and holistic care to the entire family when a child is ill. Pediatrics 2014;133:S8-S15

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Not Just Little Adults: Palliative Care Physician Attitudes Toward Pediatric Patients

Abstract: Palliative physicians tend to be willing to care for children, but perceive their level of training to be insufficient. Although additional training is endorsed, physicians favored real-time support and mentorship from a pediatric expert.

Cited by 16 publications

References 15 publications

A mixed-methods systematic review and meta-analysis of barriers and facilitators to paediatric symptom management at end of life

A mixed-methods systematic review and meta-analysis of barriers and facilitators to paediatric symptom management at end of life

Research Priorities in Pediatric Palliative Care

The Duty of the Physician to Care for the Family in Pediatric Palliative Care: Context, Communication, and Caring

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