From Fear to Confidence: Changing Providers’ Attitudes About Pediatric Palliative and Hospice Care

Abstract

Background/Aims: Children have limited access to hospice care: few existing hospice programs have dedicated pediatric teams, and adult hospice providers feel inadequately trained to care for children. The aim of this study is to increase access to pediatric hospice care by empowering adult hospice providers to care for children through a comprehensive education program. Education empowers providers by changing their attitudes from inadequacy to confidence. Methods: We developed a two-day education program to train interdisciplinary teams of adult hospice providers in pediatric care. The curriculum consists of thirteen modules to improve participants’ knowledge, skills, and attitudes. Ninety-three providers in Boston, MA, San Francisco, CA, Spokane, WA, and Anchorage, AK learned via multiple teaching methods including lectures, role-plays by professional actors, interviews of bereaved parents, discussions, self-reflections and self-care tips. Learning was evaluated with assessments given before, immediately after, and 6-months following the program. Responses were compared using a one- sided analysis of variation (ANOVA) with a significance level of alpha<0.05. Results: Providers who completed this education program improved their knowledge in twelve of thirteen modules. Self-reported confidence levels with pediatric care improved significantly in all thirteen modules (p<0.05). After this program, 79% of providers reported feeling better prepared to care for pediatric hospice patients. Improvement in confidence with communication skills rather than symptom management correlated with participants’ comfort with pediatric hospice care. Qualitative data reinforced that learners felt more prepared to care for pediatric patients. Conclusions: A two-day, high intensity education program can improve adult providers’ knowledge of and skill level with pediatric care, leading to a change in attitude from fear to confidence. This model has the potential to dramatically increase access to pediatric hospice care as it utilizes the untapped resource of existing adult hospice infrastructure.