Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
J Palliat Med. 2024 Jul;27(7):861-868. doi: 10.1089/jpm.2023.0671. Epub 2024 Mar 12.
Mental health diagnoses can co-occur with complex medical illness in pediatric patients. Pediatricians may not feel comfortable with managing psychopharmacology for patients and access to child psychiatrists can be limited. Palliative care (PC) providers follow patients with serious illness longitudinally to address burdensome symptoms that affect quality of life and may be responsible for evaluation and treatment of mental health concerns; however, education in managing psychologic distress for pediatric palliative care (PPC) providers is limited. This study seeks to describe the antidepressant prescribing practices of PPC providers and describe their level of training and comfort in assessing for anxiety and depression and prescribing psychotropic medications. An electronic survey approved by the American Academy of Hospice and Palliative Medicine was distributed nationally to PPC providers. A total of 58 providers responded to the survey (response rate 12.3%). Most reported prescribing a variety of antidepressants (79%). Very few used formal assessment tools to screen for depression (7%) or anxiety (16%). Less than a third of providers consulted child psychiatry before prescribing antidepressants (29%). More than half of providers (54.5%) had no formal training in assessment and treatment of anxiety and depression in pediatric patients. Despite this, many providers (70%) reported feeling comfortable in prescribing antidepressants while also endorsing interest in more training for behavioral health evaluation and treatment (82.5%). Limited training in assessing mental health concerns, prescribing, and managing psychopharmacology suggests an opportunity for more targeted education for pediatric PC providers regarding antidepressant prescribing practices.
精神健康诊断可与儿科患者的复杂医学疾病同时发生。儿科医生可能对管理患者的精神药理学不放心，而且儿童精神科医生的就诊机会可能有限。姑息治疗（PC）提供者会对患有严重疾病的患者进行纵向跟踪，以解决影响生活质量的负担性症状，并且可能负责评估和治疗精神健康问题；但是，管理儿科姑息治疗（PPC）提供者心理困扰的教育是有限的。本研究旨在描述 PPC 提供者的抗抑郁药处方实践，并描述他们评估焦虑和抑郁以及开处精神药物的培训水平和舒适度。经过美国姑息医学协会批准的电子调查在全国范围内分发给 PPC 提供者。共有 58 名提供者对调查做出了回应（回应率为 12.3％）。大多数报告开了各种抗抑郁药（79％）。很少有使用正式评估工具来筛查抑郁（7％）或焦虑（16％）的。不到三分之一的提供者在开抗抑郁药之前咨询过儿童精神病学（29％）。超过一半的提供者（54.5％）没有在儿科患者的评估和治疗焦虑和抑郁方面接受过正式培训。尽管如此，许多提供者（70％）在开抗抑郁药时表示感到舒适，同时也表示有兴趣接受更多关于行为健康评估和治疗的培训（82.5％）。在评估精神健康问题、开处方和管理精神药理学方面的培训有限，这表明有机会为儿科 PC 提供者提供更有针对性的关于抗抑郁药处方实践的教育。
