Monday, April 9, 2018

Assessing the Role of Maturation in Pediatric Critical Care Fellows’ Palliative Care Attitudes, Knowledge, and Skills Surrounding a Pilot Educational Initiative

S Rhodes Short
Cincinnati Children's Hospital
The importance of Palliative Care and End of Life Care (PC, EOL) for children in the Pediatric Intensive Care Unit (PICU) with life-limiting, chronic conditions is increasingly recognized as it affects patient and family outcomes and their perceptions of quality of care.  Pediatricians and trainees frequently report deficiencies in PC education and knowledge affecting their practice of Palliative Care.  Less is known about the perspectives of Pediatric Critical Care Medicine (PCCM) Fellows’ whose practice in a high mortality unit requires PC and EOL expertise. This prospective cohort study measured PC knowledge, attitudes, and skills of PCCM fellows at one center surrounding a series of PC workshops in efforts to determine how maturation impacts these indices.  Two validated, adapted tools evaluated endpoints; a Survey of PCCM fellows’ comfort, knowledge, and experience and a Communication Assessment used to evaluate communication skills in simulated encounters.  These measures indicate that PCCM fellows’ knowledge, attitudes, and skills are not affected by maturation through a pediatric intensive care fellowship.  Maturation did not alter self-appraised comfort providing PC including managing emotion, conflict, EOL symptoms, and legal issues.  Nor, did it improve objective knowledge scores (by year; 1st 54%; 2nd 46%; 3rd 51%) or communication skills (scale 0-4)(1st 2.2; 2nd 2.6; 3rd 2).  Following exposures to the workshops, more PCCM fellows found PC education helpful (90 v 60% p < 0.05) with openness more varied modalities such as workshops, online modules, and role-play versus pre-workshop. This study demonstrates PC knowledge gaps and a lack of communication skills commiserate with self-reported comfort and post-graduate year amongst PCCM fellows.  Findings indicate that PCCM fellows want and need specific curricula to affect knowledge, skills and competent practice.