Utilization of palliative care in pediatric oncology: An interprofessional evaluation of knowledge, beliefs, perceived barriers, and involvement of services

Utilization of palliative care in pediatric oncology: An interprofessional evaluation of knowledge, beliefs, perceived barriers, and involvement of services

Diver J; Prince-Paul M; Toly V; Bell C

Pediatric Blood And Cancer

2017

Childhood Cancer; Palliative Therapy; Adolescent; Child; Controlled Study; Data Analysis Software; Diagnosis; Doctor Patient Relation; E-mail; Family; Female; Hematology; Human; Male; Nurse; Pediatrics; Professional Standard

Background: The care of pediatric patients with cancer and their families is complex and evolving. Despite significant advances in outcomes, symptoms of disease and complications of therapy continue to cause pain and other symptoms that could be improvedwith the involvement of pediatric palliative care (PPC) services. The American Academy of Pediatrics (AAP)1 and Institute of Medicine (IOM)2 have published statements and recommendations in support of collaboration with PPC services for all children with serious life-threatening and life-limiting illnesses. Additionally, PPC is recommended as a standard of care in pediatric oncology in addressing the psychosocial needs of children and adolescents with cancer and their families3. Objectives: The overall purpose of this study was to evaluate the knowledge and beliefs of pediatric oncology healthcare providers (HCPs) regarding involvement of PPC and to assess potential barriers that may interfere with its utilization. Additionally, this study evaluated the current involvement of PPC services in pediatric oncology programs that belonged to a statewide hematology alliance in a large Midwestern state. Design/Method: A cross sectional, descriptive survey design guided data collection and analysis. A survey consisting of 30 questions evaluated demographic factors, institutional resources, beliefs, perceived barriers, and current utilization practices. The Qualtrics survey was distributed via email. Data were collected from 156 HCPs (nurses, advanced practice professionals, and physicians). Analysis was completed using IBM SPSS version 24. Results: Significant variability was noted in perspectives regarding PPC and utilization when comparing respondents from various professional roles, practice environments, and among those with different education and professional experience. Over 99% of respondents stated that involving PPC benefits children, however 56% reported PPC was involved "never" or "rarely" in the care of oncology patients. The leading indications for PPC involvement were consistent with advanced disease, occurring late in the trajectory, rather than upon diagnosis as recommended. The influence of practice environments was identified in this study, with free-standing children's hospitals reporting fewer barriers and increased involvement of PPC services. Conclusion: Although progress has been made, care delivered is still not congruent with the recommendations of the AAP and IOM. Knowledge gained from this study emphasizes the important role for all HCPs in advocating for support of PPC programs, education of the public, and commitment to the involvement of PPC services while caring for pediatric oncology patients.

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