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An Interprofessional Team-Based Intervention to Address Barriers to Initiating Palliative Care in Pediatric Oncology:
Jennifer K Walter1, Douglas L Hill2, Theodore E Schall2
1Children's Hospital of Philadelphia (J.K.W., D.L.H., T.E.S., S.P., C.D., K.W.C., C.F.,), Philadelphia, Pennsylvania, USA; Justin Ingerman Center for Palliative Care (J.K.W., S.P., C.F.), Philadelphia, Pennsylvania, USA.
Insights
An adaptive intervention improved pediatric oncology teams' comfort and collaboration regarding palliative care referrals. This approach is feasible and acceptable for enhancing early support for children with advanced cancer.
Area of Science:
- Pediatric Oncology
- Palliative Care
- Healthcare Interventions
Background:
- Many children with advanced cancer are not referred to palliative care, despite recommendations and parental desires for earlier support.
- Barriers exist at both individual and team levels for specialty palliative care referrals in pediatric oncology.
Purpose of the Study:
- To assess the feasibility and acceptability of an adaptive intervention designed to overcome barriers to palliative care referrals.
- To evaluate the impact of this intervention on pediatric oncology teams' practices and perceptions.
Main Methods:
- A multiple-method approach was used, including quantitative measures (comfort, cohesion, collaboration) and qualitative interviews.
- Feasibility and acceptability were assessed among clinicians from pediatric oncology teams at a single institution.
- Palliative care consult numbers were tracked before, during, and after the intervention sessions.
Main Results:
- The intervention was feasible and acceptable, with high attendance and participant satisfaction.
- Post-intervention, clinicians reported increased team cohesion, comfort with palliative care discussions, and collaboration.
- While consult numbers increased prior to sessions, they did not significantly change during or after.
Conclusions:
- An adaptive intervention effectively addresses barriers to initiating palliative care for pediatric oncology teams.
- The intervention is feasible and acceptable, showing promise for improving early palliative care access for children with advanced cancer.
Context:
Many children with advanced cancer are not referred to palliative care despite both professional recommendations to do so and bereaved parental preference for earlier support from sub-specialty palliative care.
Objectives:
To assess the feasibility, acceptability, and impact of an adaptive intervention to address individual and team-level barriers to specialty palliative care referrals.
Methods:
A multiple-method approach assessed feasibility and acceptability among clinicians from pediatric oncology teams at a single institution. Quantitative measures of comfort with palliative care consultations, team cohesion, and team collaboration were conducted before and after the intervention. Number of palliative care consults were examined before, during, and after sessions. Intervention satisfaction surveys and qualitative interviews were conducted after the intervention.
Results:
Twenty-six team members (90% of consented) attended at least one intervention session with 20 (69%) participants completing 75% or more sessions. The intervention was modified in response to participant feedback. After the intervention, participants reported greater team cohesion, comfort discussing palliative care consultation, team collaboration, process satisfaction, and decision satisfaction. Participants agreed that the training was useful, effective, helpful, and worthwhile, that they would use the skills, and that they would recommend the training to other providers. The numbers of palliative care consults increased before intervention sessions were conducted, but did not significantly change during or after the sessions. In the interviews, participants reported overall favorably regarding the intervention with some participants reporting changes in practice.
Conclusion:
An adaptive intervention to reduce barriers to initiating palliative care for pediatric oncology teams is feasible and acceptable.
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