Pediatric Palliative Care and Resident Education

Topic: Promoting Best Practices in Pediatric Palliative Care

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Improving Familiarity with Pediatric Palliative Care Among Pediatric and Internal Medicine-Pediatric Residents

Objectives:

To increase familiarity with and comfort level in providing pediatric palliative care in inpatient and outpatient settings among pediatric and internal medicine-pediatrics residents at a tertiary care children's hospital. Background: Palliative care is an emerging field in pediatrics. A policy statement issued by the American Academy of Pediatrics in 2013 recognizes the growing importance of interdisciplinary palliative care and hospice teams in caring for children with life threatening conditions. As medical advancements lead to a broader range of treatment options and increased survival of children with complex medical issues, patients and their families rely on their pediatric providers, both inpatient and outpatient, for an introduction to palliative care. However, pediatric providers at all levels of training have consistently reported minimal training, experience, or competence in key areas of palliative care. A workshop was developed by the authors and conducted among pediatric and internal medicine-pediatrics residents to address these gaps in the current resident curriculum.

Research Objectives:

The impact of the workshop was measured by changes to an 11-item, Likert-scaled questionnaire administered before and after the workshop. We hypothesized that participants of this study would report increased familiarity and confidence in pediatric palliative care after completing the curriculum.

Methods:

Participants were interns and residents of the UMMS-Baystate pediatric and internal medicine-pediatric programs. The workshop consisted of two one-hour sessions which combined didactics and practical exercises. The first session provided basic definitions and addressed the role of primary care pediatricians in providing palliative care including discussions with family regarding long term goals of care. The second focused on inpatient concepts such as pain control in terminal illness and conducting effective family meetings regarding end of life decision making. Residents were asked to fill out a questionnaire prior to the intervention and after completion of both sessions.

Results:

Residents reported an overall greater comfort with the topic after the intervention (Pre: Median 3.1, IQR 2.8-3.8, Post: Median 4.1, IQR 3.6-4.3, P = 0.003). They also reported better understanding of what pediatric palliative care is (P = 0.001) and more comfort leading a discussion regarding palliative care options for patients (P = 0.007) after the intervention.

Conclusions/implications:

After a brief workshop designed for residents, participants reported improved familiarity and comfort level with pediatric palliative care. This educational intervention was able to show that residents benefit from training in pediatric palliative care. We hope that this provides a framework for further educational sessions for pediatric residents. We also hope to use this as a framework for development of a simulation based curriculum for difficult discussions within pediatrics.

Author

  • Jessica Penney, MD
  • Medicine-Pediatrics Resident
  • University of Massachusetts Medical School - Baystate Medical Center (UMMS-Baystate)
  • 759 Chestnut St.
  • Springfield, MA 01027

Co-authors

  • Diane Dietzen, MD
  • Grace Kim, MD

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