430 - Barriers to Pediatric Palliative Care: Trainee and Faculty Perspectives Across Two Academic Centers

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 430
Publication Number: 430.147

Alyssa Levine, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Phoebe Winn, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Alexis H. Fogel, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Efrat Lelkes, UCSF, San Francisco, CA, United States; Paula McPoland, University of Washington School of Medicine, Seattle, WA, United States; Anurag Agrawal, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Jori F. Bogetz, University of Washington School of Medicine, Seattle, WA, United States

Presenting Author(s)

JB

Jori F. Bogetz, MD (she/her/hers)

Assistant Professor
University of Washington School of Medicine
Seattle, Washington, United States

First Author(s)

AL

Alyssa Levine, MD (she/her/hers)

Resident
UCSF Benioff Children's Hospital San Francisco
San Francisco, California, United States

Background: The American Academy of Pediatrics (AAP) recommends utilization of an integrated palliative care program at the time of diagnosis of a life-limiting disease for all pediatric patients, however existing literature suggests that palliative care continues to be underutilized in pediatrics despite the expansion of pediatric palliative care (PPC) programs in the two decades since the AAP made this recommendation. Previously reported barriers to the delivery of PPC include lack of adequate training, language/cultural barriers, uncertain prognosis, and overall family/physician attitude towards involvement of palliative care. Identifying ongoing barriers to the delivery of palliative care for children with serious illness is an important step in continuing to develop systems with improved access to these services.

Objective: Barriers to palliative care for children with serious illness include system constraints and concerns about apprehensive attitudes towards palliative care. This study aimed to explore trainee and faculty physician perceptions of barriers to palliative care across two pediatric centers to: 1) examine differences between trainees and faculty; and 2) compare these data with previous studies.

Design/Methods: Mixed methods study conducted in fall 2021 among pediatric trainees and faculty physicians at three pediatric hospitals in two pediatric centers in the western United States. Surveys were distributed through hospital listservs and analyzed descriptively and through inductive thematic analysis.

Results: A total of 268 trainees (50, 19%) and faculty physicians (218, 81%) participated. Of the trainees, approximately half (27, 54%) were residents. Trainees and faculty reported the same four most common barriers which were consistent with previous studies: family not ready to acknowledge incurable condition (64% trainees and 45% faculty); family preference for more life sustaining therapies than staff (52% and 39%); uncertain prognosis (48% and 38%); and parent discomfort with possibility of hastening death (44% and 30%). Time constraints, staff shortages, and conflict among family about treatment goals were also commonly reported barriers.

Conclusion(s): This study examining palliative care across two pediatric centers suggests that trainees and faculty physicians continue to identify barriers related to perceptions of family preferences and understanding of illness. Future research should examine family-centered and culturally mindful interventions to better elucidate family perspectives on their child’s illness to better align care.