Pediatric Palliative Care and End-of-Life Treatment

Pediatric Palliative Care and End-of-Life Treatment

The Pediatric Palliative Care and End-of-Life Treatment course is designed to provide information to practitioners who treat pediatric patients in the primary care with a subspecialty setting about palliative care for pediatric patients. The course content covers palliative care delivered by designated healthcare teams, primary palliative care delivery, end-of-life symptom treatment and orders for life-sustaining therapies.

Learning Objectives

  • Describe the differences between primary and subspecialty palliative care and how they complement one another
  • Describe the potential limitations of end-of-life decisions
  • Review how to identify patient wishes related to comfort, support, and remembrance at the end-of-life by family and friends
  • Identify routine health care interactions as an opportunity for long-term goals discussion
  • Clarify the family’s understanding of the patient’s illness, identify worries and fears and discuss trade-offs between clinical choices including conditions that would be desirable or unacceptable
  • Conduct a complete pain assessment appropriate for the age of the child
  • Design a pain treatment strategy for a child at the end-of-life
  • Describe the different palliative care outcomes
  • Identify concerns regarding current state of advance care planning (ACP) for children with life-threatening diseases
  • Describe the barriers to the use of MOLST

Statement of Need

There is a large amount of research about end-of-life and palliative care for pediatric patients, the vast majority of which supports the need for increased education and training. Resident physicians surveyed had little comfort with palliative care for children and wished they could receive more training in pain control, disclosing bad news, code status decision-making and end-of-life care with pediatric patients. In another study, staff members and families of patients who were deceased were surveyed about the delivery of pediatric palliative care in a hospital considering development of a palliative care team. Approximately 450 staff members (including nurses, social workers, attending and resident physicians) felt inexperienced discussing end-of-life issues, transition to palliative care and limiting resuscitation. Sixty-eight family members of deceased patients reported distress around the "uncaring" delivery of bad news and poor pain management. The results of these two surveys are representative of published literature on the topic of pediatric end-of-life and palliative care and thus support the need for our effort to provide more education on these topics.

  1. Kolarik RC, Walker G, Arnold RM. Pediatric resident education in palliative care: A needs assessment. Pediatrics 2006;117:1949-54.
  2. Contro NA, Larson J, Scofield S, Sourkes B, Cohen HJ. Hospital staff and family perspectives regarding quality of pediatric palliative care. Pediatrics 2004;114:1248-52.

Suggested Audience

  • MDs and Trainees
  • Pediatric MDs and Trainees
  • Pediatric Intensive Care Unit (ICU) MDs and Trainees

Curriculum Director

David Casavant, MD

Contributors

David Casavant, MD, Elaine Meyer, PhD, RN (Vignette Development), Richard Goldstein, MD, Emma Jones, MD, Joanne Wolfe, MD, MPH, Amy Sanderson, MD

Release Date

  • January 13, 2017