Pediatric Palliative Care Training In Fellowship: A National Survey Of Adult Palliative Medicine Fellowship Directors And Pediatric Rotation Directors.

Pediatric Palliative Care Training In Fellowship: A National Survey Of Adult Palliative Medicine Fellowship Directors And Pediatric Rotation Directors.

Malhotra S; Arnold RM

DOI: http://dx.doi.org/10.1016/j.jpainsymman.2015.12.034

Journal Of Pain And Symptom Management

2016

Objectives
Outline the current state of education and clinical
training of adult hospice and palliative medicine
(HPM) fellows in pediatric palliative care
(PPC).
Compare responses between adult HPM fellowship
and pediatric rotation directors regarding
the future of PPC education and training.
Original Research Background. With only seven
pediatric palliative care (PPC) programs in the country,
there is a lack of PPC physicians. Large numbers
of pediatric patients are cared for by palliative physicians
trained in adult fellowships. Adult HPM fellowships
require pediatric training, but little is known
about what is taught and what educators’ thoughts
are about this training.
Table 1
Univariate results
Covariate Odds ratio (95% CI) P-value
Age (>57 vs. #57 years)a 0.501 (0.206-1.219) 0.128
Indication
Non-neuropathic pain
(yes vs. no)
2.351 (1.012-5.459) 0.047
Neuropathic pain
(yes vs. no)
0.421 (0.179-0.992) 0.048
Stage (3-4 vs. 0-2) 2.004 (0.791-5.075) 0.143
Number of sessions (>3 vs. #3) 0.379 (0.125-1.152) 0.087
Tumor typeb - 0.467
a Median age
b Stratified by breast, gastrointestinal, genitourinary, thoracic, gynecologic,
hematologic, neurologic, and other cancers, and analyzed as a categorical
variable.
Vol. 51 No. 2 February 2016 Poster Abstracts 423
Research Objective. To describe adult HPM fellows’
clinical and educational exposure to PPC.
Methods. An electronic survey was sent to adult HPM
fellowship directors and their respective pediatric rotation
directors. The survey elicited information about
PPC learning objectives, didactics, and fellows’ PPC
clinical experience. Finally, directors’ attitudes about
the current and future state of PPC training was surveyed.
Data was de-identified, and descriptive statistics,
Chi-square, and sample t tests were analyzed.
Results. 41 of 98 adult HPM fellowship directors and
36 of 80 pediatric rotation directors responded
(response rates 42% and 45%, respectively). Most programs
indicated their fellows spend time observing
PPC teams manage symptom and communication issues
rather than independently managing patients
with supervision. For example, only 9 of 36 programs
allowed adult fellows to independently convert opioids
with supervision. Fellowship and pediatric rotation directors
felt somewhat (46%) or very (17%) uncomfortable
with adult HPM fellows practicing PPC.
Fellowship and pediatric rotation directors disagreed
about whether they would be likely to develop a pediatric
track within their programs (p¼0.04).
Conclusion. Most adult HPM fellows are observing
PPC teams rather than learning to independently
manage patients. Both groups of respondents indicated
discomfort with adult HPM fellows practicing
PPC.

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

March 2016 List