Barriers to palliative care for children: Perceptions of pediatric health care providers
Barriers to palliative care for children: Perceptions of pediatric health care providers
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DOI：
10.1542/peds.2006-3153
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发表时间：
2008-02-01
期刊：
影响因子：
8
通讯作者：
Kramer, Robin F.
中科院分区：
文献类型：
--
作者：
Davies, Betty;Sehring, Sally A.;Kramer, Robin F.
OBJECTIVE.目的是探讨儿科医护人员在照顾重病儿童时所遇到的姑息治疗障碍。本研究探讨了儿科供应商的看法，在学术儿童医院的临终关怀，描述了感知障碍，为儿童及其家庭的临终关怀的目标。该报告的重点是护士（n = 117）和医生（n = 81）的反应。大约一半的受访者报告了研究问卷中列出的26个障碍中的4个经常或几乎总是发生，即不确定的预后（55%），家人不准备承认不可治愈的状况（51%），语言障碍（47%）和时间限制（47%）。大约三分之一的受访者提到另外8个障碍，这些障碍通常是由于沟通问题以及疼痛和姑息治疗教育不足造成的。超过75%的工作人员认为有14个障碍偶尔或从不干扰儿科临终关怀。医生和护士之间以及ICU和非ICU工作人员之间的比较揭示了这些组之间的一些显着差异。感知的障碍，儿科临终关怀不同，从那些阻碍成人临终关怀。最常见的干扰最佳儿科临终关怀的因素涉及预后的不确定性和工作人员与家庭成员之间治疗目标的差异，其次是沟通障碍。改善工作人员在沟通技巧和姑息治疗的儿童教育可能有助于克服这些障碍，但儿科提供者必须认识到，不确定性可能是不可避免的，在照顾重病儿童固有的。一个不确定的预后应该是一个信号，开始，而不是拖延，姑息治疗。
OBJECTIVE. The goal was to explore barriers to palliative care experienced by pediatric health care providers caring for seriously ill children.METHODS. This study explored pediatric provider perceptions of end-of-life care in an academic children's hospital, with the goal of describing perceived barriers to end-of-life care for children and their families. The report focuses on the responses of nurses (n = 117) and physicians (n = 81).RESULTS. Approximately one half of the respondents reported 4 of 26 barriers listed in the study questionnaire as frequently or almost always occurring, that is, uncertain prognosis (55%), family not ready to acknowledge incurable condition (51%), language barriers (47%), and time constraints (47%). Approximately one third of respondents cited another 8 barriers frequently arising from problems with communication and from insufficient education in pain and palliative care. Fourteen barriers were perceived by > 75% of staff members as occasionally or never interfering with pediatric end-of-life care. Comparisons between physicians and nurses and between ICU and non-ICU staff members revealed several significant differences between these groups.CONCLUSIONS. Perceived barriers to pediatric end-of-life care differed from those impeding adult end-of-life care. The most-commonly perceived factors that interfered with optimal pediatric end-of-life care involved uncertainties in prognosis and discrepancies in treatment goals between staff members and family members, followed by barriers to communication. Improved staff education in communication skills and palliative care for children may help overcome some of these obstacles, but pediatric providers must realize that uncertainty may be unavoidable and inherent in the care of seriously ill children. An uncertain prognosis should be a signal to initiate, rather than to delay, palliative care.