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.
