Investigating Pediatricians' Practice, Knowledge, and Barriers in Diagnosing Cerebral Palsy
Vivian Wong1,2, Stacey D Miller2,3,4,5, Olivia Scoten6
1Rehabilitation Sciences Graduate Program, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
Insights
Pediatricians in British Columbia often diagnose cerebral palsy (CP) late. Many general pediatricians lack confidence and face barriers in diagnosing CP early, despite its importance.
Area of Science:
- Pediatric neurology
- Developmental pediatrics
Background:
- Canadian Cerebral Palsy Registry data indicates late diagnosis of cerebral palsy (CP) in British Columbia (BC) children, averaging 25 months.
- Current diagnostic timelines fall short of recommended early detection standards.
Purpose of the Study:
- To investigate the current practices and beliefs of BC pediatricians regarding CP diagnosis.
- To identify barriers and facilitators influencing the timely diagnosis of CP.
Main Methods:
- Two online surveys were administered to pediatricians, subspecialty pediatricians, pediatric neurologists, and geneticists in BC.
- Surveys assessed current practices, knowledge, beliefs, barriers, and facilitators related to CP diagnosis.
Main Results:
- Less than 60% of surveyed general pediatricians reported diagnosing CP.
- Half of respondents believed pediatricians should diagnose CP, with 93% agreeing if supported by specialists.
- Key barriers included diagnostic uncertainty and limited access to education and therapists.
Conclusions:
- General pediatricians possess CP knowledge but exhibit gaps in confidence and skills for early diagnosis.
- Lack of confidence and diagnostic uncertainty are significant barriers to timely CP diagnosis.
- Collaboration with developmental pediatricians or neurologists may facilitate earlier CP diagnosis.
Abstract:
Background/Objectives: Data from the Canadian Cerebral Palsy (CP) Registry suggests that children in British Columbia (BC) are diagnosed, on average, at 25 months of age. This is much later than currently recommended. This study aimed to examine current practices and beliefs of pediatricians in the province related to CP and CP diagnosis. Methods: All pediatricians and subspecialty pediatricians in the province were invited to participate in two consecutive online surveys. The initial survey aimed to assess current practice, knowledge of CP, and beliefs about diagnosis. The second survey, which was distributed to the same group of pediatricians, as well as pediatric neurologists and geneticists, aimed to re-assess current practice and identify specific barriers and facilitators to CP diagnosis. Results: The two surveys were completed by 76 and 59 respondents, respectively. Less than 60% of general pediatricians, in both surveys, reported diagnosing children with CP. In survey 2, only 50% of respondents felt that pediatricians should provide a diagnosis of CP. Most general pediatricians (93%) identified that pediatricians, with support from a developmental pediatrician or neurologist, should provide a diagnosis. Common barriers to an early CP diagnosis included uncertainty about other potential diagnoses and uncertainty over diagnosing at a young age. Lack of access to education and therapists to help inform the diagnosis were also frequently identified barriers. Conclusions: While general pediatricians are knowledgeable about CP, a significant proportion in those surveyed were not diagnosing CP, despite believing that early diagnosis is important. Findings from these surveys have identified that general pediatricians have gaps in knowledge, skills, and confidence in diagnosing CP. Support from a developmental pediatrician or neurology colleague was identified as a potential strategy to support earlier diagnosis.
