Knowledge and utilization of palliative radiotherapy by pediatric oncologists.

BACKGROUND AND PURPOSE: Palliative radiotherapy (PRT) is a routine part of oncology care in adult patients, but it is used much less frequently among children with incurable cancer. We surveyed Canadian pediatric oncologists to learn about their knowledge and use of PRT and to identify potential barriers to referral. METHODS: A 13-item questionnaire assessing PRT knowledge and utilization was sent to 80 Canadian pediatric oncologists. RESULTS: The survey completion rate was 80%, with most respondents being providers of palliative care for children and making referrals for PRT. Although 62% had received training in radiation oncology, only 28% had received formal palliative care training. Respondents with palliative care training were found to be significantly more knowledgeable about PRT and were more likely to refer children for PRT (p < 0.01). Only 59% of respondents thought that they had adequate knowledge about the indications for PRT. A positive correlation was found between knowledge about the indications for PRT and referral for treatment (p < 0.01). Among survey respondents, 51% believed that PRT was underutilized, and the perceived barriers to PRT referral included patient or family reluctance, distance to the cancer centre, belief that PRT has little impact on quality of life, and concerns about toxicity. CONCLUSIONS: Palliative radiotherapy is considered to be underutilized among children. This situation appears to be related, in part, to inadequate knowledge and training among pediatric oncologists, suggesting that more emphasis needs to be placed on pediatric palliative care education.

The greying of the profession.

As the 21st century begins, Americans can expect to see changes across the health care spectrum. With the drive toward market parity in the management of health care resources, it is easy to lose sight of some critical elements of the health care system that may affect the quality and delivery of care. Specifically, the work force that cares for patients in the hospital, the home, or other care settings will shift. The nursing profession will not be immune to this shift and, as nurses reach retirement age and leave the profession, their departure may leave a void that could take years to fill and profoundly alter the quality of care available.

Comparison of predelivery versus postdelivery Kleihauer-Betke stains in cases of fetal death.

A prospective study was undertaken to determine whether the delivery process could introduce a significant amount of fetal cells into the maternal circulation in patients with a fetal death. Sixty-six cases of fetal death were studied over a 39-month period. All patients had both predelivery and postdelivery Kleihauer-Betke stains performed. Of these, three (4.6%) had a massive fetomaternal hemorrhage. None of the postdelivery stains showed evidence of a significant fetomaternal hemorrhage unless results of the antepartum stain had also been positive. We conclude that the delivery process itself does not simulate a massive fetomaternal hemorrhage in cases of fetal death.