Pediatric hospice and palliative care: designing a mobile app for clinical practice.

Abstract

Most children who die from health-related conditions spend their brief lives encountering a wide variety of clinicians, from primary physicians and nurse practitioners to oncologists and neurologists. Many of these providers act as gate-keepers to hospice care through the referral process. One of the barriers to pediatric hospice and palliative care use is that pediatric clinicians generally lack an understanding of and experience with this service, which influences their decision to refer children to hospice.1 In fact, most physicians have limited or no training in core end-of-life competencies,2,3 less than 50% of residents are taught how to hold conversations about pediatric end of life,4 and over 25% of pediatricians do not even know whether local hospice services even exist.5 Although there have been significant strides to increase formal endof-life educational opportunities for clinicians, improved training in communications between clinicians and families about end of life, and increased understanding of clinicians’ hospice referral practices, very few children access hospice and palliative care at end of life.6 Perhaps it is time to try something completely different. What if we provided clinicians with a technological tool to assist them in understanding and experiencing pediatric hospice care, all in the palm of their hands? Along with formal education and training, information on pediatric hospice care could be accessible 24/7 when clinicians need it, whether in the exam room with children and their families, in the office while reviewing tests, or in the clinical conference with the care team. Although the evidence is in its infancy,7-10 the cutting-edge technology associated with smart phones and tablets (e.g., iPads) may have the potential to significantly influence health care. By providing a powerful platform, mobile applications (apps) may increase awareness of pediatric hospice care, assist clinicians’ discussions with children and families about it, and create a seamless referral to hospice that would ultimately improve access to pediatric hospice and palliative care.