Multidisciplinary Health Care Professionals' Perceptions About Pediatric End of Life Discussions: A Cross-Sectional Survey and Needs Analysis.

Abstract

Pediatric end of life (EOL) care involves complex coordination of providers from multiple disciplines. Many of these providers' experiences have not been completely described. This study aims to explicate the alignment and divergence of health care professionals' perceptions of the training, timelines, comfort, and effectiveness of pediatric EOL discussions as well as identify methods to improve medical education training. A cross-sectional survey was conducted. Analyses included Fisher's exact and post-hoc tests for all pairwise comparisons. A total of 160 of 508 eligible participants at a single academic Department of Pediatrics completed the survey (response rate 31%). Participants included attending physicians, fellows, residents, mid-level providers, nurses, and social workers. Sixty percent thought EOL discussions occurred late and 70% thought discussions should occur earlier. Attending physicians were more likely to think discussions occurred late and should occur earlier (P <.01). Residents and fellows were more likely to think participating in and leading discussions was stressful (P <.02 and P <.01, respectively). Respondents that were female, younger than forty years old, had been in their provider role less than five years, or were residents and fellows were more likely to agree that these discussions led to changes in plan of patient care (P <.05). The majority of multidisciplinary pediatric health care professionals believe pediatric EOL discussions are stressful, occur too late, and should occur earlier. Future efforts in medical education should prioritize curriculum development focusing on workshops and simulations.