A Child's Last Hours: Training for Children's Hospital Professionals in End-of-Life Care

Abstract

1.Learn a framework for approaching the dying child and the family.2.Assess symptoms of distress in the patient, the family, and the other professionals caring for a dying child.3.Learn not only “what to do” but “what to say.” In most children's hospitals, more than twice as many children die an expected death rather than from a failure of resuscitative efforts. But although all house officers and nurses are required to maintain certification in CPR and advanced life support, there has been no formal training in end-of-life care. We have developed a series of workshops to enable participants to be prepared for the challenges of caring for a dying child. A multidisciplinary group of physicians and nurses will discuss one of three cases: an infant with unsurvivable anomalies, a teen with end-stage cystic fibrosis, or an 8-year-old with advanced cancer. A facilitator will then take listeners through a guided discussion focusing on the areas of concern likely to be encountered. At the end of a 50-minute discussion, a 20-minute video will be presented. Pauses in the video will prompt participants to answer key questions that highlight the learning objectives. Self-report of confidence in the ability to care for dying children increased in all participants. Surveys of staff participating in care of a dying child indicate significant decrease in staff anxiety. These workshops are now part of the core curriculum for pediatric fellows, residents, and nurses at a major children's hospital. For the last 2 years, the workshop has also been a core curricular topic for pediatric fellows at the annual meeting of the Pediatric Academic Societies. End-of-life training enhances confidence in caring for a dying child. Multidisciplinary discussion encourages better teamwork in the care of the child and family.