Published online February 1, 2008
PEDIATRICS Vol. 121 No. 2 February 2008, pp. 282-288 (doi:10.1542/peds.2006-3153)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Web of Science (7)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Davies, B.
Right arrow Articles by Kramer, R. F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Davies, B.
Right arrow Articles by Kramer, R. F.
Related Collections
Right arrow Office Practice
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Barriers to Palliative Care for Children: Perceptions of Pediatric Health Care Providers

Betty Davies, RN, PhD, FAANa, Sally A. Sehring, MDb, J. Colin Partridge, MD, MPHb, Bruce A. Cooper, PhDa, Anne Hughes, RN, PhDa, Julie C. Philp, MDb, Aara Amidi-Nouri, RN, MSNa and Robin F. Kramer, RN, MS, PNPb

a Department of Family Health Care Nursing, University of California, San Francisco, School of Nursing, San Francisco, California
b Department of Pediatrics, University of California, San Francisco, School of Medicine and University of California, San Francisco, Children's Hospital, San Francisco, California

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.

Key Words: pediatric palliative care • pediatric end-of-life care • barriers • uncertain prognosis

Abbreviations: EOL—end of life • UCSF—University of California, San Francisco

Accepted Jul 16, 2007.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 PediatricsHome page
L. A. Thompson, C. Knapp, V. Madden, and E. Shenkman
Pediatricians' Perceptions of and Preferred Timing for Pediatric Palliative Care
Pediatrics, May 1, 2009; 123(5): e777 - e782.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
M. E. Lyon, P. A. Garvie, R. McCarter, L. Briggs, J. He, and L. J. D'Angelo
Who Will Speak for Me? Improving End-of-Life Decision-Making for Adolescents With HIV and Their Families
Pediatrics, February 1, 2009; 123(2): e199 - e206.
[Abstract] [Full Text] [PDF]