Regional adaptation of the education in palliative and end-of-life Care Pediatrics (EPEC-Pediatrics) curriculum in Eurasia

Abstract

Background: Pediatric palliative care (PPC) is a priority to improve pediatric hematology oncology (PHO) care in Eurasia. However, there are limited regional opportunities for PPC education. We describe the adaptation and implementation of a bilingual end-user Education in Palliative and End-of-Life Care (EPEC)-Pediatrics course for PHO clinicians in Eurasia.

Methods: Due to COVID-19, this course was delivered virtually, consisting of prerecorded, asynchronous lectures, and a bilingual workshop with interactive lectures and small group sessions. A pre-postcourse design was used to evaluate the knowledge acquisition of the participants including their knowledge alignment with World Health Organization (WHO) guidance, ideal timing of palliative care, and comfort in providing palliative care to their patients. Questions were mostly quantitative with multiple choice or Likert scale options, supplemented by free-text responses.

Results: A total of 44 (76%) participants from 14 countries completed all components of the course including pre- and postcourse assessments. Participant alignment with WHO guidance improved from 75% in the pre- to 90% in the postcourse assessments (p < 0.001). After participation, 93% felt more confident controlling the suffering of children at the end of life, 91% felt more confident in prescribing opioids and managing pain, and 98% better understood how to hold difficult conversations with patients and families. Most participants (98%) stated that they will change their clinical practice based on the skills and knowledge gained in this course.

Conclusions: We present a successful regional adaptation of the EPEC-Pediatrics curriculum, including novel delivery of course content via a virtual bilingual format. This course resulted in significant improvement in participant attitudes and knowledge of PPC along with an understanding of the ideal timing of palliative care consultation and comfort in providing PPC to children with cancer. We plan to incorporate participant feedback to improve the course and repeat it annually to improve access to high-quality palliative care education for PHO clinicians in Eurasia.

Keywords: Eurasia; education; pediatric oncology; pediatric palliative care.

FIGURE 1

Participating countries from Eurasia: Participating countries with a darker color associated with a larger number of participants per country.

FIGURE 2

(A) Changes in Participation Perception of Palliative Care Role After EPEC Pediatrics Course: Results of pre‐ and postcourse assessments of participant descriptions of the role of palliative care for children with cancer. The precourse survey results are in blue and the postcourse survey results are in orange. Statistically significant changes in responses occurred for those roles discussing goals of care, communication, and decision‐making among others (p < 0.05). (B) Changes in Ideal Timing of Palliative Care After EPEC Pediatrics Course: Ideal timing of initial palliative care consultation for participants in both the precourse survey and postcourse survey responses. Respondents were instructed to choose all options that applied. The figure shows the percentage of physicians who indicated each option and the statistically significant difference between the two groups. Comparing the earliest selected timing option (converted to a numeric scale), physicians indicated that the ideal timing for an initial palliative care consultation for a child.