Lefeubvre C, Viallard M-L, Schell M
Centre d'action médico-sociale de Versailles, hôpital Mignot, 177, rue de Versailles, 78150 Le Chesnay, France.
Médecine palliative périnatale et pédiatrique, Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; EA 4569, laboratoire d'éthique médicale, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France.
Arch Pediatr. 2014 Aug;21(8):834-44. doi: 10.1016/j.arcped.2014.05.012. Epub 2014 Jun 30.
The need for educational training of healthcare professionals in palliative care is an important issue. Training and practice of pediatric residents in the field of pediatric palliative care (PPC) has never been assessed, although the organization of the medical curriculum in France is currently being revised.
This study presents a national survey of pediatric residents, using a computerized anonymous questionnaire. Four different areas were studied: epidemiological data, theoretical and practical knowledge, education, and clinical experience in PPC.
The response rate was 39% (n=365/927). Whatever their age or regional location, 25% of residents did not know any details of the French law concerning patients' rights and the end of life. Experience with PPC starts very early since 77% of the first-year pediatric residents experienced at least one child in a palliative care and/or end-of-life situation. During their entire residency, 87% of the residents had experience with PPC and nearly all (96%) end-of-life care. Furthermore, 76% had participated in announcing palliative care (cancer, ICU, etc.) or a serious illness, and 45% had met and discussed with bereaved parents. Furthermore, while 97% of the pediatric residents received training in adult palliative care, mainly before their residency, only 60% received specific PPC training.
Ninety-six percent of all French pediatric residents encountered a PPC situation during their residency. That 77% of them had experienced PPC during their first year of residency shows the importance of early training in PPC for pediatric residents. Furthermore, this study points out that there is a significant lack in PPC training since 40% of all residents in the study received no specific PPC training. Progress in education remains insufficient in the dissemination of knowledge on the legal framework and concepts of palliative medicine: while the medical curriculum is being revised, we suggest that training in medical ethics and PPC should be introduced very early and systematically.
对医疗保健专业人员进行姑息治疗教育培训的需求是一个重要问题。尽管法国目前正在修订医学课程体系，但儿科姑息治疗（PPC）领域儿科住院医师的培训和实践从未得到评估。
本研究采用计算机化匿名问卷对全国范围内的儿科住院医师进行了调查。研究了四个不同领域：流行病学数据、理论和实践知识、教育以及PPC方面的临床经验。
回复率为39%（n = 365/927）。无论年龄或地区位置如何，25%的住院医师不了解法国关于患者权利和生命终结的法律细节。PPC方面的经验很早就开始了，因为77%的一年级儿科住院医师至少经历过一名处于姑息治疗和/或生命终结状况的儿童。在整个住院医师培训期间，87%的住院医师有PPC方面的经验，几乎所有人（96%）有生命终结护理方面的经验。此外，76%的人参与过宣布姑息治疗（癌症、重症监护病房等）或严重疾病，45%的人曾与失去亲人的父母见面并交谈过。此外，虽然97%的儿科住院医师接受过成人姑息治疗培训，主要是在住院医师培训之前，但只有60%接受过特定的PPC培训。
所有法国儿科住院医师中有96%在住院医师培训期间遇到过PPC情况。其中77%的人在住院医师培训的第一年就有PPC方面的经验，这表明早期对儿科住院医师进行PPC培训很重要。此外，本研究指出PPC培训存在严重不足，因为研究中40%的住院医师没有接受过特定的PPC培训。在传播关于姑息医学法律框架和概念的知识方面，教育进展仍然不足：虽然医学课程正在修订，但我们建议应尽早并系统地引入医学伦理学和PPC方面的培训。
