Pediatric Palliative Care Education Model in Low Resource Settings: A Mixed-Methods Evaluation.

CONTEXT: Globally, approximately 21.6 million children need pediatric palliative care (PPC). The greatest burden lies in low- and middle-income countries, where the demand for PPC exceeds available resources. OBJECTIVES: The objective of this study was to assess the impact of a PPC workshop on healthcare providers' self-efficacy, comfort and confidence related to the provision of PPC in a Bhutanese referral-level hospital. METHODS: This mixed-methods study included a one-and-a-half day PPC workshop with surveys administered to participants at three time points (before, immediately after, and six months after the workshop) to evaluate changes in self-efficacy, comfort and confidence. The study was conducted in January 2017 with healthcare providers at the Jigme Dorji Wangchuck National Referral Hospital in Thimphu, Bhutan. RESULTS: Forty-one providers participated in the workshop; 38 completed the post-workshop survey and 27 completed the six months post-workshop survey. Results showed statistically significant increases in comfort levels from pre- to post-workshop surveys across nearly all areas. Qualitative results supported these findings. CONCLUSION: The results of this study suggest that a short, interactive and interdisciplinary workshop, originally designed for the United States setting but adapted to a low resource context, is an effective way to improve providers' self-efficacy, comfort and confidence in the provision of PPC in resource-limited settings.

From Fear to Confidence: Changing Providers' Attitudes About Pediatric Palliative and Hospice Care.

CONTEXT: Children have limited access to hospice care: few existing hospice programs have dedicated pediatric teams, and adult hospice providers feel inadequately trained to care for children. OBJECTIVES: The aim of this study was to increase access to pediatric hospice care by empowering adult hospice providers to care for children through a comprehensive education program. Education empowers providers by changing their attitudes from inadequacy to confidence. METHODS: The authors developed a two-day education program to train interdisciplinary teams of adult hospice providers in pediatric care. The curriculum consists of 13 modules to improve participants' knowledge, skills, and attitudes. Ninety-three providers across the U.S. learned via multiple teaching methods including lectures, role plays by professional actors, interviews of bereaved parents, and self-reflections. Learning was evaluated with assessments before, immediately after, and six months after the program. Responses were compared using a one-sided analysis of variation with a significance level of alpha <0.05. RESULTS: Participants improved their knowledge in 12 of 13 modules. Self-reported confidence levels with pediatric care improved significantly in all 13 modules (P < 0.05). After this program, 79% of providers reported feeling better prepared to care for pediatric hospice patients. Qualitative data reinforced that learners felt more prepared to care for pediatric patients. CONCLUSION: A two-day, high-intensity low-cost community-based education program can improve adult providers' knowledge of and skill level with pediatric care, leading to a change in attitude from fear to confidence. This model has the potential to increase access to pediatric hospice care as it uses existing adult hospice infrastructure.