Department of Health Outcomes & Policy, University of Florida, Gainesville, FL 32610, USA.
Palliat Med. 2012 Apr;26(3):268-74. doi: 10.1177/0269216311409085. Epub 2011 Jun 16.
The provision and uptake of pediatric palliative care continues to be plagued by barriers. Several studies have documented these barriers, but none have done so with a diverse sample (most are at a single institution) or specifically about pediatric palliative care. Moreover, none have investigated the factors associated with perceived barriers. Our study has two aims: (1) to describe the barriers to pediatric palliative care as reported by a group of pediatricians practicing in two large States in the US; and (2) to identify factors associated with these perceived barriers.
Cross-sectional survey data were collected from 303 pediatricians in Florida and California.
The two greatest barriers reported by the pediatricians were related to families' reluctance to accept palliative care (95%) and families viewing palliative care as giving up (94%). Only 42% of pediatricians noted that reimbursement was a barrier. Across all the regressions, three factors were consistently associated with barriers to palliative care: race/ethnicity of pediatrician practice setting, and the percentage of low-income patients.
Our findings can be used to develop targeted educational interventions towards providers and families. Understanding the factors that are driving the low uptake in palliative care is the first step in advancing pediatric palliative care overall.
儿科姑息治疗的提供和采用仍然存在诸多障碍。有几项研究记录了这些障碍，但都没有采用多样化的样本（大多数是在单一机构），也没有专门针对儿科姑息治疗进行研究。此外，也没有研究与感知障碍相关的因素。我们的研究有两个目的：（1）描述美国两个大州的一组儿科医生报告的儿科姑息治疗障碍；（2）确定与这些感知障碍相关的因素。
从佛罗里达州和加利福尼亚州的 303 名儿科医生那里收集了横断面调查数据。
儿科医生报告的两个最大障碍与家庭不愿接受姑息治疗（95%）和家庭将姑息治疗视为放弃（94%）有关。只有 42%的儿科医生认为报销是一个障碍。在所有回归分析中，有三个因素始终与姑息治疗障碍相关：儿科医生执业环境的种族/民族，以及低收入患者的比例。
我们的研究结果可用于为提供者和家庭制定有针对性的教育干预措施。了解推动姑息治疗低采用率的因素是全面推进儿科姑息治疗的第一步。
