A survey of pediatric critical care fellows on palliative care principles applied in the ICU setting

Abstract

Learning Objectives: Pediatric intensivists are often required to practice what has been described as “primary palliative care”. This includes providing optimal symptom management, communication and family support for critically ill children with chronic or life threatening illness. However, literature suggests a gap in both knowledge and training among subspecialty trainees in the area of palliative care principles and practice. The purpose of this survey is to evaluate pediatric critical care fellows’ attitudes toward and prior experience applying palliative care principles in the PICU as well as their preferences for an educational curriculum. Data collected from this survey is being used in the development of a three year palliative care curriculum targeted specifically for pediatric critical care fellows. Methods: A 14 question Qualtrics survey was e-mailed to all program directors of ACGME accredited pediatric critical care fellowships in the United States for fellow distribution. Participation was voluntary and answers are anonymous. Qualtrics software was used to collect survey data. Results: Data is based on a 50% nationwide response rate. Over half of respondents described palliative care experience, however 30% of respondents acknowledged no training in several areas including withdrawal of technology, family support at the end of life, leading a family meeting and discussing patient prognosis. 65% of the respondents described discomfort with providing resources for hospice and discussing the ethical principles at the end of life. 70% agreed that formal training in palliative care would make them a more skilled intensivist. Greater than 50% also preferred to learn about communication and symptom management in a palliative care curriculum via case discussions or a formal palliative rotation. Conclusions: Pediatric intensivists practice palliative care on a regular basis, however the majority of fellows report the need for more formal training. A dedicated longitudinal palliative care curriculum for pediatric critical care fellows can provide the necessary knowledge and skills to close this training gap.