Pediatric Cardiology Provider Attitudes About Palliative Care: A Multicenter Survey Study
Pediatric Cardiology Provider Attitudes About Palliative Care: A Multicenter Survey Study
复制标题
DOI：
10.1007/s00246-017-1663-0
复制
发表时间：
2017-10-01
影响因子：
1.6
通讯作者：
Blume, Elizabeth D.
中科院分区：
文献类型：
--
作者：
Balkin, Emily Morell;Kirkpatrick, James N.;Blume, Elizabeth D.
虽然晚期心脏病儿童的姑息治疗咨询增加了，但心脏病专家对姑息治疗的态度知之甚少。我们试图描述心脏病专家对姑息治疗的看法，并描述他们在姑息治疗概念上的感知能力。对来自19个儿科医学中心的儿科心脏病专家和心脏外科医生进行了横断面调查。总有效率为31%(183/589)。受访者从医学院毕业的中位数为18年(2-49年)，大多数人在学术中心执业(91%)。60%的受访者认为姑息咨询发生得太晚了，大多数(85%)的受访者同意姑息咨询是有帮助的。寻求姑息治疗咨询的障碍最常被描述为“过早提及姑息治疗服务会破坏父母的希望”(45%)和“担心父母会认为我放弃了他们的孩子”(56%)。只有33%的心脏病专家报告说，在预测预期寿命方面，他们感到“非常”或“中等”称职，而超过60%的人认为有能力在生命末期照顾患有心脏病的儿童，近80%的人认为有能力讨论护理目标和代码状态。更高的感知能力与专科(心力衰竭/强化治疗与其他)(OR3.6，95%CI1.6-8.1，p=0.003)和指导性训练(OR6.27，95%CI1.8-21.8，p=0.004)相关。这些结果强调了对儿科心脏病专家进行姑息治疗技能进一步培训的必要性。加强心脏病专家的姑息治疗技能，促进与专科姑息治疗小组的合作，可能会改善对晚期心脏病儿童的整体护理。
While availability of palliative care consultation for children with advanced heart disease increases, little is known about cardiologist attitudes towards palliative care. We sought to describe perspectives of cardiologists regarding palliative care and to characterize their perceived competence in palliative care concepts. A cross-sectional survey of pediatric cardiologists and cardiac surgeons from 19 pediatric medical centers was performed. Overall response rate was 31% (183/589). Respondents had a median of 18 years of experience since medical school (range 2-49) and most practiced at academic centers (91%). Sixty-percent of respondents felt that palliative care consultations occur "too late" and the majority (85%) agreed that palliative care consultations are helpful. Barriers to requesting palliative care consultation were most frequently described as "referring to palliative care services too early will undermine parents' hope" (45%) and "concern that parents will think I am giving up on their child" (56%). Only 33% of cardiologists reported feeling "very" or "moderately" competent in prognosticating life expectancy while over 60% felt competent caring for children with heart disease around end of life, and nearly 80% felt competent discussing goals of care and code status. Greater perceived competence was associated with subspecialty (heart failure/intensivist vs. other) (OR 3.6, 95% CI 1.6-8.1, p = 0.003) and didactic training (OR 6.27, 95% CI 1.8-21.8, p = 0.004). These results underscore the need for further training in palliative care skills for pediatric cardiologists. Enhancing palliative care skills among cardiologists and facilitating partnership with subspecialty palliative care teams may improve overall care of children with advanced heart disease.