Palliative Care Competencies Research Articles

Internal Medicine Residents' Beliefs, Attitudes, and Experiences Relating to Palliative Care: A Qualitative Study.

Internal medicine residents are frequently called upon to provide palliative care to hospitalized patients, but report feeling unprepared to do so effectively. Curricular development to enhance residents' palliative care skills and competencies requires an understanding of current beliefs, attitudes and learning priorities. We conducted a qualitative study consisting of semi-structured interviews with ten internal medicine residents to explore their understanding of and experiences with palliative care. All of the residents interviewed had a sound theoretical understanding of palliative care, but faced many challenges in being able to provide care in practice. The challenges described by residents were system-related, patient-related and provider-related. They identified several priority areas for further learning, and discussed ways in which their current education in palliative care could be enhanced. Our findings provide important insights to guide curricular development for internal medicine trainees. The top five learning priorities in palliative care that residents identified in our study were: 1) knowing how and when to initiate a palliative approach, 2) improving communication skills, 3) improving symptom management skills, 4) identifying available resources, and 5) understanding the importance of palliative care. Residents felt that their education in palliative care could be improved by having a mandatory rotation in palliative care, more frequent didactic teaching sessions, more case-based teaching from palliative care providers, opportunities to be directly observed, and increased support from palliative care providers after-hours.

Physician Perspectives on Palliative Care for Children With Neuroblastoma: An International Context.

Studies have shown that children with cancer globally lack access to palliative care. Little is known regarding physicians' perceptions of palliative care, treatment access, and self-reported competence in providing palliative care. Members of the Global Neuroblastoma Network (online tumor board) were surveyed. Eighty-three respondents met inclusion criteria; 53 (64%) completed the survey. Most respondents trained in high-income countries (HIC) but practice in low- and middle-income countries (LMIC), and care for more than five patients with neuroblastoma annually. WHO Essential Medicines in palliative care varied in availability, with incomplete access across LMIC centers. Nonpharmacologic therapies were inconsistently available. Contrary to international definitions, 17% of respondents inappropriately considered palliative care as that initiated only after curative therapy is stopped. Mean physician competence composite score (Likert scale 1-5, 5 = very competent) in providing symptomatic relief and palliative care across phases of care was 2.93 (95% CI 2.71-3.22). Physicians reported significantly greater competence in symptom management during cure-directed therapy than during end-of-life (P = 0.02) or when patients are actively dying (P = 0.007). Practicing in HIC, prior palliative care training, having access to radiotherapy, and not having to turn patients away due to bed shortages were significantly predictive of perceived competence in providing palliative care at end of life. An international sample identified gaps in treatment and palliative care service availability, in understanding the definition of palliative care, and in self-reported competence in providing palliative care. Increased perceived competence was associated with training, which supports the need for increased palliative care education and advocacy, especially in LMIC.

Integrating Principles and Practice of Palliative Medicine in Emergency Care

Trajectories of serious illness and dying have changed in the last century; people now live longer, often with prolonged debility in advanced stages of illness. With more options for aggressive interventions at the end of life, patients and families face increasingly complex medical decisions. Many of these patients will present repeatedly to the emergency department (ED) before their death, and emerging evidence suggests that integrating palliative care into the treatment of advanced illness, including in the emergency setting, can improve outcomes. This review covers changing trajectories of illness and death, palliative care as a medical specialty, emerging models of integration, essential palliative care competencies for the ED clinician, and managing the actively dying patient in the ED. Figures show palliative care through the trajectory of serious illness, theoretical trajectories of disease, life expectancies for women and men, and patient-centered communication. Tables list philosophy of palliative care, domains of suffering addressed by palliative care, palliative performance scale, NURSE mnemonic for accepting and responding to emotion, palliative care communication competencies in the intensive care unit: effect on clinical outcomes and family satisfaction, and SPIKES mnemonic for breaking bad news. This review contains 4 highly rendered figures, 6 tables, and 113 references

Developing a palliative care competence framework for health and social care professionals: the experience in the Republic of Ireland

PurposeCompetence-based education in health and social care has been promoted through the Tuning Process in Europe. This papers reports on the process of developing a Palliative Care Competence Framework for...

Capsule Commentary on Dzeng et al., Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: a Qualitative Inquiry.

D zeng et al. 1 explore a potentially role-defining experience of internal medicine training: providing care one believes to be futile near the end of life. Using interviews at three academic institutions, the authors solicited residents’ and fellows’ experiences providing treatments that provoked moral distress or conflicted with their moral beliefs. Emergent themes revealed that trainees viewed such experiences as Btorture,^ both for the patients whose suffering they were powerless to alleviate and to trainees themselves, who were left feeling powerless, numb, and cynical. The study is not meant to explore the prevalence of futility, but rather to delve deeply into how trainees process and cope with this professional trauma. The recruitment strategy may have affected sampling bias in two ways. Residents with profoundly negative experiences may have been more likely to participate, and the interviews themselves may have offered a venue to reflect on lingering emotions. Alternatively, those with more severe distress may have been underrepresented, if they felt concerned about relieving these experiences or about the safety in speaking honestly. Still, the findings raise important considerations for medical educators. The study also goes beyond questions about whether trainees can define futility, focusing on how they maintain their sense of self during arduous training years. While the definitions continuously evolve through societal and legal debate, these ethical challenges exact a toll. Potential solutions may be found in relationship-centered care (RCC). Emphasizing the importance of clinician authenticity, RCC recognizes that we bring our own emotions and values into our relationships with patients, family members, and team members, and acknowledges how we are shaped by these relationships. Training programs and health care systems need infrastructure to support honest discussions about such challenging cases and the emotions they evoke, whether during rounds with palliative care consultants or mentored family meetings. Such venues may alleviate trainee suffering—and perhaps the unstated suffering of their attendings—by allowing all to express their doubts and grief over treatment decisions. As programs adopt essential palliative care competencies, the heart of these skills remain the mindful practice and self-care that allow clinicians to negotiate and navigate these tough decisions.

Consensus-Based Palliative Care Competencies for Undergraduate Nurses and Physicians: A Demonstrative Process with Colombian Universities.

Background: A World Health Assembly (WHA) resolution adopted in 2014 strongly encourages member states to integrate palliative care (PC) in undergraduate training for health professionals.Objective: The study objective was to describe a consensus-based process workshop to develop PC competences for medical and nursing schools in Colombia and to present a summary of the findings.Methods: The workshop included 36 participants representing 16 medical and 6 nursing schools from 18 universities in Colombia. Participants were distributed in four thematic groups. Using the International Association for Hospice and Palliative Care (IAHPC) List of Essential Practices (LEP) as guidance, they were asked to discuss and define PC competencies at the undergraduate level. Participants provided feedback and approved each recommendation, and then were asked to complete an evaluation.Results: The resulting competences were separated into six categories: (1) Definition and Principles of PC, (2) Identification and Control of Symptoms, (3) End-of-Life Care, (4) Ethical and Legal Issues, (5) Psychosocial and Spiritual Issues, and (6) Teamwork. A comparative analysis revealed that treatment of several symptoms in the IAHPC LEP (pain, dyspnea, constipation, nausea, vomit, diarrhea, delirium, and insomnia) were included in the competencies. All of the IAHPC LEP related to psychological/emotional/spiritual care was included. The evaluation rate of return was 80%. The assessment was very positive: total score of 4.7/5.0; SD = 0.426), with 89% considering the workshop to be helpful.Conclusion: The workshop provided an opportunity for individuals from different disciplines to discuss competencies and achieve consensus. The resulting competencies will be helpful in the development of PC curricula for physicians and nurses throughout schools in Colombia and other countries.

Perceived competency and knowledge in palliative and end-of-life care among physicians at an academic institution.

59 Background: Given the importance of palliative and end-of-life (EOL) care in terminally ill patients (pts), it is crucial that physicians feel comfortable in leading EOL discussions and possess adequate knowledge in palliative care skills. Methods: We conducted an online survey of physicians at our institution to evaluate competency and knowledge in palliative and EOL care. The survey consisted of 39 questions in self-assessed skills and a 26-question validated knowledge test. Results: There were a total of 70 respondents across specialties: 30% internal or family medicine, 24.3% surgery, 14.3% pediatrics, 31.4% other, 5.7% medical/surgical oncology. The median (M) age was 52.5 (33-99), 64% were male. 18.6% reported caring for 1 to 2 dying pts and 35.7% for 3 to 10 or more dying pts in the previous 3 months (mos). 45.7% had 1 or more EOL discussions in the previous 3 mos. There was no association between (btw) the number of dying pts cared for and the number of EOL discussions, p < 0.89. 31.4% felt comfortable and 15.7% felt very comfortable providing palliative/EOL care, while 18.6% felt very uncomfortable or uncomfortable and the plurality, 34.3%, felt neither comfortable nor uncomfortable. Physicians who were comfortable or very comfortable were 1.63 times more likely to have 2 or more EOL discussions in the previous 3 mos, p < 0.0001. When rating competency level in various skills, 80% reported average (avg) to above avg skill in pain assessment, 58.6% below avg to avg in opioid dosing, 64.3% below avg to avg in managing opioid side effects, 65.7% avg to above avg in assessing non-pain symptoms. The M score on the knowledge test was 69.2 (46.1-88.4) % correct, with most incorrect answers in managing cancer pain. There was no correlation btw test score and overall comfort level, p < 1.567. Conclusions: In our cohort, the plurality of respondents felt neither comfortable nor uncomfortable in providing palliative and EOL care, self-assessed competency was often rated as below avg or avg, and overall comfort level did not correlate with knowledge test scores. This study highlights the need to improve continuing medical education in palliative and EOL care in order to enhance the quality of care physicians provide to pts.

Family physicians' role in palliative care throughout the care continuum: stakeholder perspectives.

While palliative care is still often viewed as care for the final stage of life provided usually by specialist health care professionals, ideally, a palliative care approach would start at an earlier stage, with an important role being assigned to the family physician (FP). However, the description of what the FP's tasks would be in the integration of a palliative care approach into the care continuum remains vague. To explore the views of FPs, nurses and patients about the tasks of the FP in palliative care for people with a life-limiting illness from diagnosis onwards. We performed 18 interviews with people with cancer, organ failure or dementia and 6 focus groups, 4 with FPs and 2 with community nurses. Analysis was guided by a thematic content analysis procedure to categorize perceived tasks into overarching themes. The tasks attributed to the FP could be categorized into four roles: FP as (i) available medical expert, (ii) communicator, (iii) collaborator and (iv) life-long learner committed to improving their palliative care competencies by training. Some perceived tasks varied depending on the different phases of illness (such as around diagnosis), while others were applicable throughout the whole illness course. Participants mostly had the same perception of the FPs' tasks, but there was disagreement on, for example, the timing of care planning. Our results help to elucidate the tasks and roles required of FPs to make integration of a palliative care approach into the care continuum possible.

Palliative Care in Advanced Lung Disease: The Challenge of Integrating Palliation Into Everyday Care

The tendency toward "either/or" thinking (either cure or comfort) in traditional biomedical care paradigms does little to optimize care in advancing chronic illness. Calls for improved palliation in chronic lung disease mandate a review of related care gaps and current clinical practices. Although specialist palliative services have their advocates, adding yet another element to an already fragmented, often complex, care paradigm can be a challenge. Instead, we propose a more holistic, patient-centered approach based on elements fundamental to palliative and best care practices generally and integrated as needed across the entire illness trajectory. To support this approach, we review the concept of primary palliative care competencies, identify vulnerability specific to those living with advanced COPD (an exemplar of chronic lung disease), and describe the need for care plans shaped by patient-centered communication, timely palliative responsiveness, and effective advance care planning. A costly systemic issue in the management of chronic lung disease is patients' increasing dependency on episodic ED care to deal with preventable episodic crises and refractory dyspnea. We address this issue as part of a proposed model of care that provides proactive, collaborative case management and the appropriate and carefully monitored use of opioids. We encourage and support a renewed primary care resolve to integrate palliative approaches to care in advanced lung disease that, in concert with judicious referral to appropriate specialist palliative care services, is fundamental to what should be a more sustainable systematic improvement in palliative care delivery.

A Pilot Study of Palliative Care Provider Self-competence and Priorities for Education in Kenya.

This study explored palliative care provider self-competence and priorities for future education in an inpatient hospice setting in Kenya. Self-competence scores for clinical skills and patient and family communication skills were hypothesized to differ according to provider type. A descriptive, cross-sectional study design was piloted at Kimbilio Hospice, a 26-bed rural, inpatient facility in Kenya. A quantitative survey instrument entitled, "Self assessment of clinical competency and concerns in end-of-life care," was administered to participants. Survey responses were collected from 5 clinical staff, 11 caregivers, and 8 support staff. Data were analyzed using Kruskal-Wallis test to compare between mean scores. Statistically significant differences were found in 5 self-competence variables: performing a basic pain assessment, use of oral opioid analgesics, assessment and management of nausea/vomiting and constipation, and discussing an end-of-life prognosis with a patient's family member (P < .05). Sixteen participants (66%) selected pediatric palliative care as their top priority for future education. The findings support the hypothesis that palliative care providers have varying levels of self-competence. Improving education to build palliative care competencies in adult and pediatric palliative care in sub-Saharan Africa is recommended.

Awareness and implementation of recommendations made by the Strategic Planning Summit for Pain and Palliative Care Pharmacy in PGY1 pharmacy residency programs

PurposePublished surveys suggest that pain and other related symptoms continue to be undertreated. For this reason, all health care professionals, including pharmacists, need training in effectively assessing and managing pain and related symptoms. Recently, consensus recommendations have been published for pain and palliative care (PPC) competencies and experiences within post-graduate year 1 (PGY1) residency programs. This survey sought to assess agreement of PGY1 pharmacy Residency Program Directors (RPDs) with these recommendations, as well as barriers to their potential implementation and current learning experience availability. MethodsFollowing institutional review board approval, 754 invitations to participate were sent to RPDs. Survey items included program demographics, availability of PPC learning experiences, RPD agreement with consensus recommendations, and perceived barriers to not offering these experiences when absent. ResultsOf the 154 RPDs responding (response rate 20.4%), 93% were unaware of the consensus recommendations. On average, in responding programs, seven of the 21 recommendations were currently being moderately addressed within in responding programs. Only 43 (28%) offered a dedicated rotation in PPC, with common barriers identified being a lack of specialized preceptors (63%), inadequate rotation settings (29%), and lack of resident interest (18%). ConclusionsExperiences in pain and/or palliative care are integral to the training of pharmacists regardless of anticipated practice setting. Unfortunately, a lack of specialized preceptors and training experiences precludes a greater percentage of PGY1 pharmacy residents from attaining minimum competencies in the care of patients with pain or requiring supportive care. Current pharmacy residency training programs must be resourceful in providing these opportunities to their trainees.

Resource allocation issues concerning early palliative care.

The concept of early palliative care (ePC) has received enormous recognition in the field of cancer care. Increasing evidence supports this approach, but outside the research arena, the implementation of sustainable clinical concepts rely on solutions for practical problems such as funding issues. Therefore, the article presented here discusses economic considerations associated with different concepts of ePC. The specialist approach: the most frequently cited ePC trials assessing examine the concurrent provision of specialist palliative care in addition to routine care. Most of this specialist palliative care has been provided by multiprofessional teams in an outpatient setting of tertiary care centers. A number of the research groups have also provided data about the resource utilizations of this approach. From this, a rough estimate of the cost of early specialist palliative care can be derived. Yet, in many parts of North-America, Europe and other regions, funding modes for such outpatient specialist palliative care is non-existent. Recent studies have pointed out that ePC for inpatients is associated with cost-savings. These cost savings are even more pronounced the earlyer specialist palliative care is integrated in the care for the patients. Strengthening of general palliative care: most institutions recommend that palliative care as an approach should be strengthened as a part of standard care. To accomplish this, different measures such as teaching of general palliative care competencies of oncology teams, routine symptom assessment or the mandatory implementation of advanced care planning in care trajectories are being promoted. Due to the heterogeneity of these approaches, cost calculations are difficult, but can be weight against cost-saving estimated associated with for example less utilization of futile diagnostic and therapeutic procedures. Researchers, health care providers and policy makers need to distinguish the different concepts behind ePC before providing cost estimates. Detailed information is provided in this article. From our view, it is evident that neither of the two approaches (general vs. specialist) can be a one-or-the-other choice. Successful ePC will most likely rely on a joint effort of all medical disciplines and profession in close cooperation and early integration of specialist PC services. For such an approach, additional resources may be necessary, but from the public health perspective, cost-savings can also be assumed.

Utilization of palliative care principles in nursing home care: Educational interventions.

This study is part of the overarching PVIS (Palliative Care in Nursing Homes) project aimed at building competence in palliative care for nursing home staff. Our objective was to describe nursing home staff's attitudes to competence-building programs in palliative care. Three different programs were developed by specialist staff from three local palliative care teams. In all, 852 staff at 37 nursing homes in the greater Stockholm area participated. Staff from 7 nursing homes participated in 11 focus-group discussions. Variation in size between the seven nursing homes initiated purposeful selection of staff to take part in the discussions, and descriptive content analysis was used. The results suggest that staff reported positive experiences as they gained new knowledge and insight into palliative care. The experiences seemed to be similar independent of the educational program design. Our results also show that staff experienced difficulties in talking about death. Enrolled nurses and care assistants felt that they carried out advanced care without the necessary theoretical and practical knowledge. Further, the results also suggest that lack of support from ward managers and insufficient collaboration and of a common language between different professions caused tension in situations involved in caring for dying people. Nursing home staff experienced competence-building programs in palliative care as useful. Even so, further competence is needed, as is long-term implementation strategies and development of broader communication skills among all professions working in nursing homes.

Abstracts from theCenter to Advance Palliative Care National Seminar Pathways to Quality Palliative CareNovember 13–15, 2014Orlando, Florida

Abstracts from theCenter to Advance Palliative Care National Seminar Pathways to Quality Palliative Care<i>November 13–15, 2014</i><i>Orlando, Florida</i>

Out-of-hours palliative care: what are the educational needs and preferences of general practitioners?

ObjectivesOffering genuine choice to patients over place of care and death requires the provision of high-quality palliative care 24/7. This study examines the confidence of out-of-hours general practitioners (GPs) in...

Demonstrating Medical Student Competency in Palliative Care: Development and Evaluation of a New “OSCE” Station (S779)

Objectives Describe a process for gauging implementation of the National Comprehensive Cancer Network’s PalliativeCareGuidelinesby itsmember institutions. Identify the impediments to NCCN Palliative Care Guideline adoption by member institutions. Original Research Background. To promote access and delivery of quality, evidence-based palliative care (PC), the National Comprehensive Cancer Network (NCCN) has developed PC guidelines to guide symptom screening, assessment, PC interventions, and reassessment by the oncology team. Research Objectives. We sought to evaluate adoption of the guidelines among NCCN member institutions. Methods. An invitation and reminders to participate in an online survey were sent to NCCN PC guidelines panel members. If a panel member did not reply, individuals at the same institution were approached. Results. Responses were received from 21 (84%) of the 25 member institutions. All of the institutions report having an interdisciplinary team with PC expertise. Forty-three percent have guidelines or triggers in place for the use of PC services. Only 10% actively employ the NCCN guidelines to screen for PC needs or make PC referrals; the guidelines are more often used to guide patient assessment (38%) and clinical practice (43%). When asked to endorse other PC referral criteria, 76% indicated the discretion of the oncology provider(s) and 29% the National Consensus Project for Quality Palliative Care. Sixty-two percent agree providers concur on the elements of PC and 29% agree as to who should receive PC. Only 19% agree early integration of PC should occur for all oncology patients and 43% agree PC referrals occur in a timely and efficient manner. The most frequently cited barriers to the provision of quality PC are attitudes toward PC (71%), insufficient staffing (61%) and limited financial resources (57%). Conclusions. Adoption of the guidelines at NCCN member institutions is incomplete. There appears to be a lack of consensus about when and for whom PC should be provided. Implications for Research, Policy, or Practice. Future research should be designed to enhance understanding of the barriers to care and improve implementation of the guidelines.

Improving Human Immunodeficiency Virus/AIDS Palliative Care in Critical Care

Critical care nurses provide palliative care to many patients; often, this includes the patient diagnosed with human immunodeficiency virus (HIV)/AIDS. Ongoing education about both palliative care and this complex diagnosis prepares the nurse to provide compassion and informed care. This study examines the effects of an educational intervention addressing palliative care in the intensive care unit and the needs of the HIV/AIDS patients and families. The study will evaluate the critical care nurses' knowledge and competence in caring for this population following the educational sessions. Thirty critical care nurses were recruited from the critical care unit at a hospital in the south. An HIV/AIDS palliative care course provided participants background knowledge, general principles, and opportunities for critical thinking regarding palliative care. A pretest and posttest on palliative care were provided to each subject to assess knowledge and confidence in palliative care in critical care nursing. The convenience sample of 30 nurses attained a mean pretest score of 82.9%. Their scores improved to 93.5% following the palliative care course. The nurses felt they improved in providing palliative care to patients and in taking responsibility for their practice. Ninety-three percent of the participants wanted to incorporate a palliative care course in nursing orientation. The course improved nurses' knowledge of palliative care for HIV/AIDS patients and their competency in palliative care. Thus, the palliative care course gave nurses deeper insight and improved their ability to provide competence palliative care.

Conditions of Palliative Home Care: The Case of Family Physicians in Switzerland

Family physicians (FPs) play a key role in the treatment and care for terminally ill men and women. However, little is known about the conditions and challenges of FPs services in this domain. Aim of this article is to identify, how FPs can be supported in palliative home care in Switzerland by the availability of guidelines and advance directives, community-based palliative care structures, education and training, as well as remuneration of palliative home care services. Case studies in three Swiss cantons, namely Lucerne (LU), Vaud (VD), and Ticino (TI) are the basis of the following investigation. They not only represent French, Italian and German language regions but differ considerably with respect to the history of palliative care. Within and between cantons documents, questionnaires and expert interviews are analyzed thematically with the help of content-analysis. The results illustrate considerable shortcomings with respect to the backing of FPs palliative home care services. The availability and use of guidelines as well as advance directives is rather small in general practice, and FPs care and treatment at the end of life is only marginally supported by ambulant care structures, especially in rural areas. Also the coordination of services and collaboration between specialists and generalists is poorly developed. Furthermore FPs possibilities to acquire competencies in palliative care are strongly limited, and palliative home care provided by FPs is poorly financed. The results draw a rather bleak picture with respect to the support of FPs palliative home care services in Switzerland today. Though considerable steps towards implementing palliative care have been made in recent years in general, conditions for FPs medical services have to get improvedstrongly. Major efforts have to be made to foster the recognition and implementation throughout Switzerland.

Palliative Care and Nursing in Palestine, 2015

As cancer is the second leading cause of death in Palestine (14.2%), and as it is diagnosed usually in the late stage, this makes its burden heavier on both patients and the healthcare system, and leads to poorer quality of life (QoL) of patients. This leads to great need initiate and implement palliative care (PC) to improve patients QoL. PC nursing is on the priority within such endeavors, which is still in its early development and needs national and international support. On the clinical aspect, only one PC team, composed of a nurse and a social worker, is implementing PC consultations in Bethlehem, depending on minor support from local community. On the other hand, opioids are still under prescribed by limited number of physicians only, with no access of nurses to prescription or modification. Hospice service or nurses are not available yet in the country. Knowledge of PC and its importance is limited among nurses, as well as other healthcare professionals, in Palestine. There is a new initiative to include PC education in the curriculum of undergraduate nurses in the governmental education in the ministry of health, but still no official programs in PC yet. Nevertheless, there are some workshops in PC conducted by the Middle East Cancer Consortium and AL-Sadeel Society. Even though, limited researches done in Palestine suggest a positive attitude of Palestinian nurses toward PC and willingness for its education. Needs for development of PC include, after adopting supporting legislations and policies within the national system, proper PC training and certification, public awareness, and formation of PC teams. Future outlooks include initiating educational programs in palliative care nursing at the undergraduate and post graduate levels, integrating PC into the national health plans and education, valuing competent palliative care, and more national and international concerns and funds for those struggling to initiate PC in Palestine.

Comparison of the Educational Needs of Neonatologists and Neonatal Nurses Regarding Palliative Care in Taiwan.

Education and training are very critical to development of high-quality neonatal palliative care. However, little investigation has been done into Taiwanese neonatal clinicians' educational needs regarding neonatal palliative care. The purposes of this study were to characterize and identify neonatal clinicians' educational needs regarding neonatal palliative care. A cross-sectional descriptive surveyed method via a self administered questionnaire was used in this research. Thirty neonatologists were recruited by a convenience sampling and 30 nurses were recruited by a randomized sampling. Out of sixty neonatal clinicians' survey, few had received the education in neonatal palliative care. Most reported minimal training in, experience with, and knowledge of neonatal palliative care. For neonatologists, two of twelve most strongly-felt educational needs were "discussing palliative care and ethical decision-making with parents" (70%) and "informing parents the poor progress in neonates" (63.3%). In contrast, neonatal nurses wanted more training regarding pain control (50%). Communication skills, including the discussing poor prognosis, bad news, and code status and talking with neonates about end-of-life care, were the educational need most commonly felt by both neonatologists and nurses. Survey data from neonatologists and neonatal nurses in Taiwan indicate a need for further training on a range of neonatal palliative care competencies.