Evaluation of residents' level of comfort with palliative care concepts before and after

Evaluation of residents' level of comfort with palliative care concepts before and after

Pohl C E

Pediatrics

2018

child; comfort; conference abstract; controlled study; hospice; human; life; nomenclature; nurse practitioner; palliative therapy; patient care; pediatric hospital; residency education; skill; tertiary health care; total quality management

Introduction The specialty of Pediatric Palliative care and Hospice is growing exponentially, however, residency training programs are often underprepared to meet the evolving educational needs of their trainees with regards to the field. While Pediatric Advance Care Teams (PACT) have been established at many children's hospitals, they are frequently in different stages of development. Residents are often at the forefront of patient care, and may find themselves in difficult end-of-life situations requiring skills not formally taught in their training. As PACT teams grow into their roles at various children's hospitals, residents will continue to be challenged by unfamiliar and unique situations, resulting in a need to educate residents in palliative care. Methods The objective of the quality improvement project was to evaluate residents' understanding of several concepts of palliative care, develop an educational intervention, and to reevaluate resident understanding following this intervention. Goal improvement was 40% over 2 months. 91 pediatric residents of a single program associated with a tertiary care pediatric hospital were invited to participate in the survey. The pretest survey addressed residents' level of comfort of 5 concepts in palliative care on a scale from 1 (least) to 10 (most). The pretest evaluated comfort describing palliative care terminology, comfort discussing concepts with family, and their ability to identify the roles for residents and PACT. After collection, a conference was prepared by the investigators in collaboration with the PACT team physician and nurse practitioner to ensure consistency within the institution. The conference was designed to address knowledge gaps revealed by the survey. Audio and visuals were recorded and made accessible online for all residents. Following the conference, a document was distributed to the residents, addressing the educational needs concerning palliative care, as well as scholarly links to numerous AAP resources on palliative care. A post intervention survey identical to the pretest was then administered. Results 55 residents responded to the pretest survey, with 16 responding post intervention. Pretest mean scores were calculated from the 5 questions, with an average score of 5.68 of a possible 10. Post test mean scores were averaged with result of 7.60 of a possible 10. Post test intervention mean scores showed an increase of 34% from baseline. Conclusion These results show that after intervention, there is a significant increase in residents' level of comfort regarding understanding of basic concepts of palliative care. With educational materials which concisely address the needs determined by initial evaluation, we were able to effectively engage the residents through both audio and visual means to achieve an appreciable and replicable intervention for educating residents in palliative care. Moving forward, we will focus on continuing educational and clinical opportunities for residents in collaboration with the growth of the PACT team.

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