Pccm fellows' palliative care knowledge and attitudes surrounding a pilot educational initiative

Pccm fellows' palliative care knowledge and attitudes surrounding a pilot educational initiative

Short SR; Poynter-Wong S; Flint H

Critical Care Medicine

2018

palliative therapy; Child; Clinical Article; cohort analysis; comfort; communication skill; Curriculum; Death; Human; Intensive Care; legal aspect; Likert scale; maturation; prospective study; role playing; simulation; spike

Learning Objectives: The importance of Palliative and End of Life Care (PC, EOL) for children in the PICU with life-limiting, chronic conditions is increasingly recognized (1). Robust PC improves outcomes by symptom score, cost, and length of life (2-4). Pediatric Critical Care fellows (PCCF) report deficiencies in PC education and knowledge (5-7). This study measured PC knowledge, attitudes, and skills of PCCF at one center assessing how maturation impacts those indices. Methods: Prospective cohort study of PCCF surrounded a series of PC workshops. Two validated adapted tools evaluated endpoints; a survey of PCCFs' comfort, knowledge and experience (8) and a Communication Assessment (CA) using SPIKES methodology (9). Graduating fellows (GF, n = 4) and a current fellow cohort (CF, n = 11) completed the survey. In a simulation workshop, faculty (n = 2) used the CA to rate fellows' communication skills (n = 15). A CF cohort (n = 11) completed the post-curriculum survey. Results: Assessed PCCF's knowledge, attitudes and skills show maturation alone inadequately instructs PC, reflecting national data (5-9). Maturation did not alter self-appraised comfort providing PC in 6 (Likert scale 1-5)(composite scores by year; 1st 3.6, 2nd 3.3; 3rd; 3.5). With training, comfort managing conflict and emotion (1st 3.2; 3rd 3), symptoms at EOL (1st 3.7; 2nd 3.6; 3rd 4.1), and legal aspects of PC (1st 3.6; 3rd 3.7) did not change. Nor, did it improve objective knowledge scores (by year; 1st 54%; 2nd 46%; 3rd 51%; GF 65% p> 0.05) or communication skills by CA (scale 0-4)(1st 2.2; 2nd 2.6; 3rd 2). PC exposure, gauged by care conferences (cc) led and recalled deaths on clinical duty (cc 1-25; M= 8.5; deaths 5-36; M 13.5), did not correlate with comfort, communication skills, or knowledge. Post-workshop, more PCCF found PC education helpful (90 v 60%) with new openness to workshops, online modules, and role-play versus didactics and observation pre-workshop. Conclusions: This study demonstrates knowledge gaps and a lack of communication skills commiserate with self-reported comfort in PC among PCCF. Maturation did not improve these endpoints. Fellows are also open to and request more PC education after exposure to a multi-modal educational intervention. Findings indicate that PCCF want and need specific curricula to affect PC knowledge and skills.

2018

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