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Comparing Pediatric Surgeons' and Palliative Care Pediatricians' Palliative Care Practices and Perspectives in
Danielle Ellis1, Emanuele Mazzola2, Joanne Wolfe3
1Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA.
Insights
Pediatric surgeons and palliative care physicians have differing views on consultation timing and barriers, leading to late involvement of pediatric palliative care (PPC) in seriously ill surgical patients. Improved collaboration and training are needed to optimize care.
Area of Science:
- Pediatric Surgery
- Palliative Care Medicine
- Healthcare Collaboration
Background:
- Interactions between surgical and pediatric palliative care (PPC) teams for critically ill children remain under-explored.
- Understanding differing perspectives is crucial for enhancing care coordination.
Purpose of the Study:
- To compare pediatric surgeons' and PPC physicians' views and practices regarding PPC for surgical patients.
- To identify discrepancies in consultation timing, perceived barriers, and definitions of PPC.
Main Methods:
- A survey was distributed to members of the American Pediatric Surgical Association and the Pediatric Interest Group of the American Academy of Hospice and Palliative Medicine.
- Data were collected from 124 pediatric surgeons and 71 PPC physicians.
Main Results:
- A significant disparity exists in reported PPC consultation frequency, with surgeons reporting more frequent consultations than PPC physicians perceive (43% vs. 67% rarely/never consulted).
- PPC physicians were more likely to feel involved too late (43% vs. 21%) and preferred earlier consultation at diagnosis (54% vs. 34% at deterioration).
- Surgeons' primary barrier to consultation was concern about parental perception (29%), while PPC physicians perceived more barriers to consultation by surgeons.
Conclusions:
- Surgical culture and misperceptions about parental acceptance contribute to delayed PPC referrals, often when curative options are limited.
- PPC can enhance care by focusing on patient/family priorities, managing distress, and addressing non-surgical symptoms.
- Formalized training for surgeons and intentional interdisciplinary collaboration are recommended to overcome barriers and knowledge gaps in PPC provision.
Purpose:
The nature of interactions between surgical and pediatric palliative care (PPC) teams caring for seriously ill children is unknown. This study compares pediatric surgeons' and PPC physicians' perspectives and practices regarding PPC in surgical patients.
Methods:
A survey was administered to members of the American Pediatric Surgical Association and Pediatric Interest Group of the American Academy of Hospice and Palliative Medicine.
Results:
One hundred twenty-four pediatric surgeons (31% female, 17.2 mean years of experience) and 71 PPC physicians (69% female, 10.1 mean years of experience) participated. Forty-three percent of surgeons reported consulting PPC often for children with serious illnesses. However, most PPC physicians (67%), said they are rarely/never consulted by surgeons (p = 0.002). PPC physicians were more likely to report that PPC involvement was too late (43% vs 21%, p = 0.005). More surgeons than PPC physicians felt that an appropriate time for PPC consultation was during serious illness deterioration (30% vs 7%, p = 0.05), whereas PPC physicians preferred consultation at diagnosis (54% vs 34%, p = 0.05). More PPC physicians (67%) than surgeons (17%) agreed that invasive interventions could be considered a form of PPC (p = 0.002). The most reported barrier to PPC consultation by surgeons (29%) was concern that parents would think the surgical team was giving up. PPC physicians were more likely to perceive barriers to consultation by surgeons than surgeons themselves (p < 0.001).
Conclusion:
While pediatric surgeons value PPC involvement, surgical culture and misperception of parental resistance to PPC involvement lead to palliative care consultation only when illness acuity and severity are high, the possibility of curability is low, and death seems imminent. Seeking to understand patient and family priorities in care, managing patient and parental psychological distress, and treating non-surgical symptoms are areas where PPC can improve patient care. Barriers to PPC use and self-reported knowledge gaps in PPC provision may be mitigated by formalized PPC training for surgeons and intentional collaboration between the two groups.
Type Of Study:
Survey.
Level Of Evidence:
N/A.
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