Project ECHO pediatric palliative care: Impact of tele-mentoring and education series in Nepal

Abstract

Background: The vast majority (97%) of children needing palliative care live in low- and middle-income countries (LMICs). In Nepal, more than 43 000 children need palliative care, yet access to pediatric palliative care (PPC) is extremely limited. A lack of education for health care providers (HCPs) has been identified as a significant barrier to ensuring access to PPC in LMICs. Project ECHO (Expansion for Community Healthcare Outcomes) is an online training model which provides teaching and support for providers in resource-limited settings. Aim(s): To develop, implement, and assess the impacts of a Project ECHO for PPC in the South Asian context. Our specific objectives were to assess participation levels, program acceptability, changes in self-efficacy and attitudes towards palliative care among HCPs as well as self-reported practice changes after six months. Method(s): Electronic surveys were distributed at baseline, at the end of the program (10 weeks), and after 6 months. Result(s): The program consisted of weekly 60-minute ECHO sessions conducted weekly (June-August 2020). There were 41 participants who successfully completed the program. Survey respondents included nurses (49%), physicians (39%), and other health care professionals (12%). The majority (88%) worked at government hospitals, and most (55%) cared for 10 or fewer children per month who required palliative care. Scores for comfort and attitudes about palliative care showed improvements after participation in the program, with stronger improvements noted in providing bereavement care and breaking bad news, particularly for physicians. Conclusion(s): Project ECHO suggests a novel educational model which can be used to build capacity among health care providers in resource limited settings.