Commentary by:
Dr. Omolabake Akinseye MD – Jim Pattison Children’s Hospital, Saskatoon Dr. Akinseye is a NICU physician working in level II and III NICU with a special interest in sepsis control and infant nutrition.
Feature Article
Ul-Ain, R., Faizan, M., & Mohamed, A. (2021). Pediatric palliative care: Competency and educational needs assessment in pediatricians of a developing country. Pediatric Hematology Oncology Journal, 6(3), 118–122.
Commentary
Palliative care is a field of medicine that provides care for patients experiencing serious illness and their families at all stages of their disease trajectory.1
According to the World Health Organization (WHO), this field of medicine is recognized under the human right to health. It improves the quality of life of patients and their families facing challenges associated with life-threatening illnesses, whether physical, psychological, social, or spiritual. They estimate that globally only 14% of patients who need palliative care receive it. In the pediatric population, 98% of those needing palliative care live in low-and middle-income countries with almost half of them living in Africa. In order to achieve Sustainable Development Goal 3, achieving health and well-being for all at all ages, it is important for countries to strengthen palliative care services.2,3
I trained and worked as a Pediatrician in Nigeria, the most populous country in Africa. Working in one of the busiest children’s hospitals in Lagos, the largest city in Nigeria and Africa, I agree that there is a huge unmet need in palliative care. Empowering health professionals with the right knowledge and providing continuing education and support is key to bridging the gap in the practice of palliative care in low-middle-income countries (LMIC).
To understand what dimension of intervention is required, it is pertinent to assess the current level of competency in practicing pediatricians-hence my interest in this article.
I remember countless scenarios where very sick children and their families receive little or no palliative support from the health team who are more inclined to focus only on the management of the acute clinical symptoms related to the primary disease condition. Some of the factors that may be responsible for this are inadequate knowledge, skills, and experience of the health care team in providing palliative care, lack of access to drugs for palliative relief (putting into consideration that health care services are usually fee-for-service), cultural beliefs about dying and uncertainties about its benefits as some equate it to ‘giving up on a loved one’.
A multi-pronged approach is required to mitigate this. If I were to pick one step out of a long list of possible solutions, it would be improving the knowledge and skills of healthcare team members while raising public awareness as well. There is evidence to support inadequate education among all cadres of healthcare staff in providing palliative care.1,4
I was drawn to this study because of its objectives. In order to understand the best approach to intervention, it is pertinent to do a situational analysis among practicing health professionals. The authors aimed to assess the competency and educational needs of Pediatricians in Pakistan- an LMIC. It was designed as a multi-center, self-reported, cross-sectional, online survey among 284 Pediatric residents and junior staff pediatricians from various teaching hospitals. Low or below average competence was reported in the assessment and management of terminal delirium, agitation, and anxiety; use of adjuvant analgesics, discussing treatment withdrawal, use of parenteral opioid analgesics, and developing family-centered goals of care. Improved competence was observed with the increasing years of training. I am curious to know how the senior residents and young staff developed their competence in this field. Perhaps from individually seeking external training or attending funded courses or perhaps by trial and error. It is important to formalize and integrate palliative care teaching in the residency training program as well as the medical school training curriculum.
I feel fortunate to have gotten exposure to the practice of palliative care medicine during my fellowship training in BC, Canada with an excellent team of diverse professionals who were accessible, supportive, and quite involved in practical teaching and demonstration. It was a wonderful learning opportunity, and I would make every effort to carry the learning forward into my future practice and patient interactions.
Health care should be universal, the authors concluded with a valid statement that Pediatricians in a developing country are eager to learn more about palliative care but significant gaps exist in their country’s current training program that needs to be bridged. To ensure continuity and maintenance of acquired skills, there should be structured programs for practicing professionals that fosters continuing education and learning.
References
- García-Quintero, X., Claros-Hulbert, A., Tello-Cajiao, M. E., Bolaños-Lopez, J. E., Cuervo-Suárez, M. I., Durán, M. G. G., Gómez-García, W., McNeil, M., & Baker, J. N. (2022). Using EmPalPed—An Educational Toolkit on Essential Messages in Palliative Care and Pain Management in Children—As a Strategy to Promote Pediatric Palliative Care. Children, 9(6), 838.
- World Health Organization. (n.d.). Palliative Care. www.who.int/health-topics/palliative-care
- World Health Organization. (n.d.). Targets of Sustainable Development Goal 3. https://www.who.int/europe/about-us/our-work/sustainable-development-goals/targets-of-sustainable-development-goal-3
- Hurley-Wallace, A., Wood, C., Franck, L. S., Howard, R. F., & Liossi, C. (2019). Paediatric pain education for health care professionals. Pain Rep., 4(1), e701-e701.