New Directions in Pediatric Palliative Care Education for Preclinical Medical and Nursing Students

Abstract

Objectives: Since insufficient education has partially contributed to challenges in providing pediatric palliative care (PPC), a cross-sectional questionnaire study was conducted to explore the knowledge, attitudes, and educational needs of preclinical medical and nursing students in Hong Kong.

Methods: Pretested self-administered 44-item questionnaires with written informed consent were distributed to 241 medical and nursing students at Li Ka Shing Faculty of Medicine, the University of Hong Kong, between February and March 2019. This questionnaire covered eleven categories related to participants' knowledge of and attitudes towards PPC. A convenience sampling method was used. Data analysis was performed with descriptive statistics, chi-squared, and Fisher's exact test.

Results: Only 38.3% of participants had heard of PPC before, but 73.5% advocated for its local commencement. A large number, with more in nursing, misunderstood fundamental palliative concepts and pain assessment methods. Many reported that undergraduate curricula should include PPC since they were not prepared to deal and cope with dying children. More medical students identified multidisciplinary approaches in PPC while less believed that they were mentally prepared to discuss death and dying. The majority indicated family as the final decision maker, even for teenage patients. Although a large proportion agreed that PPC should be delivered at home since the diagnosis of a life-limiting illness, only a few were aware of the suggested referral structure.

Conclusions: Most healthcare students were supportive of PPC despite their limited exposure. PPC education on palliative principles, pain management, multidisciplinary approaches, and emotional coping skills is needed and welcomed among students.

Keywords: Interprofessional; Medical education; Medical education research; Nursing education; Pediatric palliative care; Undergraduate.

Fig. 1

Flowchart illustration of study. PPC, pediatric palliative care

Fig. 2

Key questions on philosophical principles, multidisciplinary approaches, and pain management of PPC. a Key responses on philosophical principles and multidisciplinary approaches of PPC. b Key responses on pain management of PPC. PPC, pediatric palliative care

Fig. 3

Perceived preferred PPC service locations and indications for PPC referral. a Perceived preferred PPC service locations. b Perceived indications for PPC referral with definitions of life-limiting diseases. Criteria 1, life-threatening conditions for which curative treatment may be feasible but can fail. Criteria 2, conditions which premature death is inevitable with long-term intensive treatment aimed at prolonging life and allowing participating in normal activities (e.g., cystic fibrosis). Criteria 3, progressive conditions without curative treatment options (e.g., muscular dystrophy). Criteria 4, irreversible but non-progressive conditions causing severe disability leading to susceptibility to health complications and likelihood of premature death (e.g., severe cerebral palsy). c Perceived indications for PPC referral with case study questions. Case 1, a 16-year-old boy is diagnosed from recurrent acute myeloid leukemia. Even with aggressive treatment with side effects, the cancer still recurs. Case 2, a 2-month-old baby boy is diagnosed to suffer from recurrent acute myeloid leukemia. Even with aggressive treatment with side effects, the cancer still recurs. Case 3, a 2-month-old baby boy is diagnosed to suffer from cystic fibrosis. Even with treatment, the symptoms still worsen. PPC, pediatric palliative care

Fig. 4

Attitudes and beliefs towards PPC. a Personal views on PPC. b Self-confidence in providing PPC. PPC, pediatric palliative care