Knapp C, Thompson L, Madden V, Shenkman E
Department of Epidemiology, University of Florida, Gainesville, Florida 32610, USA.
Palliat Med. 2009 Jul;23(5):418-24. doi: 10.1177/0269216309102618. Epub 2009 Feb 27.
Children have traditionally been referred to palliative care when curative treatments were exhausted. Recently, experts have suggested that children could benefit from palliative care early in their courses of illness. Using survey data from 303 paediatricians in Florida and California, this study assesses if paediatricians would refer children to palliative care early in their course of illness. Results showed that more years in practice were associated with decreased odds of referring children to palliative care. Academic practice setting and more Medicaid patients were associated with greater odds of referral prior to the end of life. Hispanic paediatricians, those with more experience and those who practice in a hospital setting were associated with decreased odds of referral prior to the end of life. Results suggest that health planners who wish to implement or refine integrated paediatric palliative care programs should consider outreach strategies targeted at paediatricians with specific characteristics.
传统上，当治愈性治疗手段用尽时，儿童才会被转至姑息治疗。最近，专家们提出，儿童在病程早期就能从姑息治疗中获益。本研究利用来自佛罗里达州和加利福尼亚州303名儿科医生的调查数据，评估儿科医生是否会在儿童病程早期就将其转至姑息治疗。结果显示，从业年限越长，将儿童转至姑息治疗的几率越低。学术实践环境以及更多的医疗补助患者与临终前转诊几率增加有关。西班牙裔儿科医生、经验更丰富的儿科医生以及在医院环境中执业的儿科医生与临终前转诊几率降低有关。结果表明，希望实施或完善综合性儿科姑息治疗项目的卫生规划者应考虑针对具有特定特征的儿科医生制定推广策略。
