Healthcare professionals’ experiences of the barriers and facilitators to community paediatric pain management at end-of-life

ABSTRACT

BackgroundInadequate pain management in community paediatric palliative care is common. Evidence to inform improved pain management in this population is limited.ObjectivesTo explore the barriers and facilitators to paediatric community-based pain management for infants, children and young people at end-of-life as perceived by healthcare professionals.MethodsSemi-structured qualitative interviews were conducted with 29 healthcare professionals;12 nurses, five GPs, five consultants and registrar doctors, two pharmacists and five support therapists working in primary, secondary or tertiary care in the UK and involved in community end-of-life care of 0–18-year-olds. The data corpus was analysed using an inductive thematic analysis.ResultsSeven themes emerged from the data parents’ abilities, beliefs and wellbeing;working relationships between families and healthcare professionals, and between healthcare teams;healthcare professionals’ knowledge, education and experience;health services delivery;nature of pain treatment;and paediatric-specific factors. Across themes, the concepts of partnership working between families and healthcare professionals, and within healthcare teams, and sharing expertise were prevalent.ConclusionsIt is important that healthcare professionals and parents work together, and that mutual trust is built up through two-way conversations. Community healthcare professionals would benefit from education from experienced multidisciplinary teams to effectively manage paediatric pain at end-of-life and prevent emergency hospice or hospital admissions, particularly during the COVID-19 pandemic.