Pediatric Advanced Care Team (PACT), The Hospital for Sick Children, Toronto, Ontario, Canada (N.J., K.W.); Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada (N.J., K.W., R.A., C.T.M.).
Department of Supportive Care, University Health Network, Toronto, Ontario, Canada (K.M., C.Z., K.W.).
J Pain Symptom Manage. 2022 Nov;64(5):461-470. doi: 10.1016/j.jpainsymman.2022.07.011. Epub 2022 Jul 26.
Children and adults with advanced cardiac or respiratory disease may benefit from specialized palliative care (SPC), but there has been little SPC research in this area.
To explore pediatric cardiologists' and respirologists' (pediatric clinicians) beliefs about and referral practices to SPC and compare these results to adult cardiologists and respirologists (adult clinicians).
Pediatric and adult clinicians were sent a survey exploring SPC referral practices and beliefs. Responses were summarized with descriptive statistics. Pediatric and adult clinicians' responses were compared using Pearson's chi-square test.
The response rate was 56% (989/1759); 9% (87/989) were pediatric clinicians. Pediatric clinicians were more likely than adult clinicians to be female, work in an academic center, and experience fewer patient deaths (P<0.001). Pediatric clinicians reported better access to SPC clinical nurse specialists, spiritual care specialists and bereavement counselors (P<0.001), while adult clinicians reported better access to palliative care units (P<0.001). Pediatric clinicians referred to SPC earlier, while adult clinicians tended to refer after disease directed therapies were stopped (P<0.001). More than half of all clinicians felt patients had negative perceptions of the phrase "palliative care". Although most clinicians were satisfied with SPC quality (73-82%), fewer adult clinicians were satisfied with SPC availability (74 vs. 47%; P<0.001). Fewer pediatric clinicians felt that SPC prioritized oncology patients (13 vs. 53%; P<0.001).
There are important differences between pediatric and adult clinicians' beliefs about and referral practices to SPC. This may reflect unique features of pediatric diseases, provider characteristics, care philosophies, or service availability.
患有晚期心脏或呼吸系统疾病的儿童和成人可能受益于专门的姑息治疗（SPC），但在该领域的 SPC 研究很少。
探讨儿科心脏病专家和呼吸科专家（儿科临床医生）对 SPC 的信念和转诊实践，并将这些结果与成人心脏病专家和呼吸科专家（成人临床医生）进行比较。
向儿科和成人临床医生发送了一项调查，以探讨 SPC 转诊实践和信念。使用描述性统计方法总结了回应。使用 Pearson's chi-square 检验比较了儿科和成人临床医生的回应。
应答率为 56%（989/1759）；9%（87/989）为儿科临床医生。与成人临床医生相比，儿科临床医生更有可能是女性、在学术中心工作、经历的患者死亡人数较少（P<0.001）。儿科临床医生报告说，他们更容易获得 SPC 临床护士专家、精神关怀专家和丧亲咨询师（P<0.001），而成人临床医生报告说，他们更容易获得姑息治疗病房（P<0.001）。儿科临床医生更早地转诊至 SPC，而成年临床医生则倾向于在停止疾病导向治疗后转诊（P<0.001）。超过一半的临床医生认为患者对“姑息治疗”一词有负面看法。尽管大多数临床医生对 SPC 的质量感到满意（73-82%），但较少的成年临床医生对 SPC 的可用性感到满意（74 对 47%；P<0.001）。较少的儿科临床医生认为 SPC 将肿瘤患者放在优先地位（13 对 53%；P<0.001）。
儿科和成人临床医生对 SPC 的信念和转诊实践存在重要差异。这可能反映了儿科疾病的独特特征、提供者特征、护理理念或服务可用性。
