ABSTRACT
The care of children in the U.S. with life-limiting illnesses is inadequate. Misallocated resources, flawed assumptions and models of care, and a lack of appropriate professional education foster a costly, inefficient system that falls short of its true potential. This article details the evolution of a regional, shared approach to address these issues, the District of Columbia Pediatric Palliative Care Collaboration (DCPPCC), and includes its evolution, preliminary clinical results, and assessment of barriers encountered.
Subject(s)
Health Personnel/organization & administration , Palliative Care/organization & administration , Pediatrics/organization & administration , Quality of Life , Terminal Care/organization & administration , Adolescent , Biomedical Research/organization & administration , Child , Child, Preschool , Continuity of Patient Care/organization & administration , District of Columbia , Female , Health Personnel/psychology , Humans , Infant , Infant, Newborn , Inservice Training , Male , Palliative Care/psychology , Program Evaluation , Quality of Health Care/organization & administration , Referral and Consultation/organization & administration , Terminal Care/psychologySubject(s)
Analgesia/standards , Pain, Intractable/therapy , Palliative Care/standards , Terminal Care/standards , Terminally Ill/psychology , Analgesia/ethics , Analgesia/methods , Analgesics/adverse effects , Analgesics/therapeutic use , Chronic Disease/psychology , Chronic Disease/therapy , Humans , Nerve Block/standards , Pain, Intractable/physiopathology , Pain, Intractable/psychology , Palliative Care/ethics , Patient Care Team , Physician-Patient Relations/ethics , Terminal Care/ethicsABSTRACT
BACKGROUND: House officers frequently lack basic competency in end-of-life care. Few studies have evaluated educational interventions deliberately utilizing physicians' learning strategies, particularly in the context of a concomitant effort at modification of practice patterns. STUDY DESIGN: Prospective controlled trial utilizing pre-intervention and post-intervention cross-sectional surveys. PARTICIPANTS: Internal medicine residents at a university hospital in their first, second, and third years of training. SURVEY: A 25-item survey modified from previously published instruments. INTERVENTION: Residents in the intervention group utilized an experiential learning intervention (integrated, end-of-life clinical pathway: PEACE Tool). The control group delivered care in a standard fashion. DATA ANALYSIS: SURVEY item and test responses were tabulated and pair-wise comparisons between group means evaluated statistically using two-sample t tests. RESULTS: Fifty-four internal medicine residents (n = 24, first-year; n = 17, second-year; and n = 13, third-year) completed the survey. Pre-intervention mean scores on a 16-item knowledge scale were 7.4 (46% correct) for first-year, 8.1 (51%) for second-year, and 9.2 (58%) for third-year residents. Eighteen first-year residents participated in the intervention phase (8 in the intervention, 10 in the control). Mean overall knowledge scores were 46% higher in the intervention group compared to the control group (11.8 versus 8.1 p < 0.001). CONCLUSIONS: A time-effective, practice-based strategy led to a significant improvement in knowledge of end-of-life care. Prior to implementation of this strategy competency in end-of-life care was suboptimal among internal medicine residents, in spite of desirable attitudes. Factual knowledge improved slightly with standard, pre-intervention training and experience.
