Kimberley Widger1,2, Joanne Wolfe3, Stefan Friedrichsdorf4,5, Jason D Pole6, Sarah Brennenstuhl1, Stephen Liben7, Mark Greenberg8, Eric Bouffet9,10, Harold Siden11, Amna Husain12,13, James A Whitlock9,10, Myra Leyden1, Adam Rapoport2,10,12,14. 1. 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto , Toronto, Ontario, Canada . 2. 2 Paediatric Advanced Care Team, Hospital for Sick Children , Toronto, Ontario, Canada . 3. 3 Pediatric Palliative Care Service, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts. 4. 4 Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota , Minneapolis, Minnesota. 5. 5 Department of Pediatrics, University of Minnesota , Minneapolis, Minnesota. 6. 6 Research, Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada . 7. 7 Pediatric Palliative Care Program, The Montreal Children's Hospital , Montreal, Quebec, Canada . 8. 8 Policy and Clinical Affairs, Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada . 9. 9 Department of Hematology/Oncology, Hospital for Sick Children , Toronto, Ontario, Canada . 10. 10 Department of Paediatrics, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada . 11. 11 Canuck Place Children's Hospice, Department of Pediatrics, University of British Columbia , Vancouver, Canada . 12. 12 Department of Family and Community Medicine, University of Toronto , Toronto, Ontario, Canada . 13. 13 Temmy Latner Centre for Palliative Care, Mount Sinai Hospital , Toronto, Ontario, Canada . 14. 14 Emily's House Children's Hospice , Toronto, Ontario, Canada .
Abstract
BACKGROUND: Lack of pediatric palliative care (PPC) training impedes successful integration of PPC principles into pediatric oncology. OBJECTIVES: We examined the impact of an enhanced implementation of the Education in Palliative and End-of-Life Care for Pediatrics (EPEC®-Pediatrics) curriculum on the following: (1) knowledge dissemination; (2) health professionals' knowledge; (3) practice change; and (4) quality of PPC. DESIGN: An integrated knowledge translation approach was used with pre-/posttest evaluation of care quality. Setting/Subjects/Measurements: Regional Teams of 3-6 health professionals based at 15 pediatric oncology programs in Canada became EPEC-Pediatrics Trainers who taught the curriculum to health professionals (learners) and implemented quality improvement (QI) projects. Trainers recorded the number of learners at each education session and progress on QI goals. Learners completed knowledge surveys. Care quality was assessed through surveys with a cross-sectional sample of children with cancer and their parents about symptoms, quality of life, and care quality plus reviews of deceased patients' health records. RESULTS: Seventy-two Trainers taught 3475 learners; the majority (96.7%) agreed that their PPC knowledge improved. In addition, 10/15 sites achieved practice change QI goals. The only improvements in care quality were an increased number of days from referral to PPC teams until death by a factor of 1.54 (95% confidence interval [CI] = 1.17-2.03) and from first documentation of advance care planning until death by a factor of 1.50 (95% CI = 1.06-2.11), after adjusting for background variables. CONCLUSION: While improvements in care quality were only seen in two areas, our approach was highly effective in achieving knowledge dissemination, knowledge improvement, and practice change goals.
BACKGROUND: Lack of pediatric palliative care (PPC) training impedes successful integration of PPC principles into pediatric oncology. OBJECTIVES: We examined the impact of an enhanced implementation of the Education in Palliative and End-of-Life Care for Pediatrics (EPEC®-Pediatrics) curriculum on the following: (1) knowledge dissemination; (2) health professionals' knowledge; (3) practice change; and (4) quality of PPC. DESIGN: An integrated knowledge translation approach was used with pre-/posttest evaluation of care quality. Setting/Subjects/Measurements: Regional Teams of 3-6 health professionals based at 15 pediatric oncology programs in Canada became EPEC-Pediatrics Trainers who taught the curriculum to health professionals (learners) and implemented quality improvement (QI) projects. Trainers recorded the number of learners at each education session and progress on QI goals. Learners completed knowledge surveys. Care quality was assessed through surveys with a cross-sectional sample of children with cancer and their parents about symptoms, quality of life, and care quality plus reviews of deceased patients' health records. RESULTS: Seventy-two Trainers taught 3475 learners; the majority (96.7%) agreed that their PPC knowledge improved. In addition, 10/15 sites achieved practice change QI goals. The only improvements in care quality were an increased number of days from referral to PPC teams until death by a factor of 1.54 (95% confidence interval [CI] = 1.17-2.03) and from first documentation of advance care planning until death by a factor of 1.50 (95% CI = 1.06-2.11), after adjusting for background variables. CONCLUSION: While improvements in care quality were only seen in two areas, our approach was highly effective in achieving knowledge dissemination, knowledge improvement, and practice change goals.
Entities:
Keywords:
oncology; palliative care education; pediatric palliative care
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