Building competence in pediatric end-of-life care.

BACKGROUND: Pediatric end-of-life care involves multiple decision-makers including the patient, the family, and the health care provider. Although some information exists on the role of patient and family values on decision making, little is known about what influences the health care provider's decisions and performance.
OBJECTIVE: A survey was conducted to collect data on health care providers who provide pediatric end-of-life care to determine what factors influence provider confidence in managing eleven different end-of-life care issues.
DESIGN: An electronic 34-question survey was circulated in 2005 at a single children's hospital in Western Michigan.
RESULTS: One hundred fifty-seven responses were received. Age had the highest association with confidence. Older responders reported more confidence than their younger colleagues (odds ratio [OR] 3.3-26.1 on eight issues). Other provider factors associated with higher confidence levels included male gender (OR 3.6-11.2 on five issues), experience (OR 2.7-4.6 on five issues) and not being religious (OR 3.1-3.4 on three issues). Responders who received formal education during training felt better prepared than those who did not (17.1% versus 3.8% felt at least well prepared, respectively).
CONCLUSIONS: Age and experience create confidence in managing pediatric end-of-life care issues. Other provider variables including gender and religious beliefs may also influence confidence on some issues. Although formal education helps providers feel better prepared to care for children with terminal conditions, the majority of providers still feel no more than adequately prepared by their training. More emphasis on experience-driven education delivered by seasoned educators may improve confidence in delivering pediatric end-of-life care.