A Provider-Based Survey To Assess Bereavement Care Knowledge, Attitudes, and Practices in Pediatric Oncologists (original) (raw)

Abstract

Background: Bereavement support is a core tenet of palliative care that may prove difficult for clinicians as it is time-consuming, emotionally charged, and not emphasized in pediatrics training. This project is intended to describe the opinions, knowledge, and practice of bereavement care among pediatric oncologists to identify gaps in clinical care. Procedures: An internet-based survey instrument was pilot tested, refined, and distributed to pediatric oncologists in the United States. Statistical analysis was performed using SAS 9.2. Results: Electronic surveys were distributed to 2,061 pediatric oncologists and 522 surveys (25%) were fully completed. Participants were asked how likely they are to engage in particular bereavement activities (phone calls, condolence cards, memorial services, family meetings, or referrals for counseling) following the death of a pediatric cancer patient. Eighty-two percent of participants, at least, sometimes engage in at least one of these activities. Being female, an attending physician, and increased time in clinical practice were predictive of active participation in bereavement care. Nearly all participants (96%) believe that bereavement care is part of good clinical care, while 8% indicate that bereavement support is not their responsibility. Lack of time and resources were the biggest barriers to providing bereavement support. Conclusions: The majority of pediatric oncologists engage in clinical practices to support bereaved families. Lack of time and physical resources pose significant barriers to clinician's efforts. Additional supports should be explored to increase pediatric oncology physician uptake of bereavement care practices.

Loading...

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.

References (35)

  1. American Academy of Hospice and Palliative Medicine; Center to Advance Palliative Care; Hospice and Palliative Nurses Association; Last Acts Partnership; National Hos- pice and Palliative Care Organization: National concensus project for quality palliative care: Clinical practice guide- lines for quality palliative care, executive summary. J Palliat Med 2004;7:611-627.
  2. Hendrickson KC: Morbidity, mortality, and parental grief: A review of the literature on the relationship between the death of a child and the subsequent health of parents. Palliat Support Care 2009;7:109-119.
  3. Shear MK: Grief and mourning gone awry: Pathway and course of complicated grief. Dialogues Clin Neurosci 2012; 14:119-128.
  4. Rosenberg A, Baker K, Syrjala K, Wolfe J: Systematic review of psychosocial morbidities amoung bereaved par- ents of children with cancer. Pediatr Blood Cancer 2012;58: 503-512.
  5. Price J, Jordan J, Prior L, Parkes J: Living through the death of a child: A qualitative study of bereaved parents experi- ences. Int J Nurs Stud 2011;48:1384-1392.
  6. Gilmer M, Foster T, Vannatta K, et al.: Changes in parents after the death of a child from cancer. J Pain Symptom Manage 2012;44:572-582.
  7. Joint Commission Resources, Joint Commisssion Certifi- cation for Palliative Care: Comprehensive Certification Manual for Disease Specific Care, 1st ed. 2015.
  8. Field MJ, Behrman RE: When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. J R Soc Med 2003;96:419-420.
  9. Borasino S, Morrison W, Silberman J, et al.: Physicians' contact with families after the death of pediatric patients: A survey of pediatric critical care practitioners' beliefs and self-reported practices. Pediatrics 2008;122:e1174-e1178.
  10. Eggly S: Physicians' conceptualization of ''closure'' as a benefit of physician-parent follow-up meetings after a child's death in the pediatric intensive care unit. J Palliat Care 2013;29:69-75.
  11. Meert KL, Eggly S, Berger J, et al.: Physician' experiences and perspectives regarding follow-up meetings with parents after a child's death in the pediatric intensive care unit. Pediatr C 2011;12:e64-e68.
  12. Jones BL, Contro N, Koch KD: The duty of the physician to care for the family in pediatric palliative care: Context, communication, and caring. Pediatrics 2014;133 Suppl:S8- S15.
  13. Kutner JS, Kilbourn KM: Bereavement: Addressing chal- lenges faced by advanced cancer patients, their caregivers, and their physicians. Prim Care 2009;36:825-844.
  14. Kusano AS, Kenworthy-Heinige T, Thomas CR: Survey of bereavement practices of cancer care and palliative care physicians in the Pacific Northwest United States. J Oncol Pract 2012;8:275-281.
  15. Chau NG, Zimmermann C, Ma C, et al.: Bereavement practices of physicians in oncology and palliative care. Arch Intern Med 2009;169:963-971.
  16. Giddings G: The ties that bind: A reflection on physician grief. Support Care Cancer 2010;18:1355-1357.
  17. Feudtner C, Hayes R, Haynes G, et al.: Deaths attributed to pediatric complex chronic conditions: National trends and implications for support care services. Pediatrics 2001;107: E99.
  18. Lichtenthal WG, Sweenew CR, Roberts KE, et al.: Bereave- ment follow up after the death of a child as a standard of care in pediatric oncology. Pediatr Blood Cancer 2015;62(S5): S834-S869.
  19. Hilden BJM, Emanuel EJ, Fairclough DL, et al.: Attitudes and practices among pediatric oncologists regarding end- of-life care: Results of the 1998 American Society of Clinical Oncology Survey. J Clin Oncol 2001;19:205-212.
  20. Steele AC, Kaal J, Thompson A, et al.: Bereaved parents and siblings offer advice to healthcare providers and re- searchers. J Pediatr Hematol Oncol 2013;35:253-259.
  21. Bright KL, Huff MB, Hollon K: A broken heart-the phy- sician's role: Bereaved parents' perceptions of interactions with physicians. Clin Pediatr (Phila) 2009;48:376-382.
  22. Back AL, Young JP, Mccown E, et al.: Abandonment at the end of life from patient, caregiver, nurse, and physician perspectives: Loss of continuity and lack of closure. Arch Intern Med 2009;169:474-479.
  23. Dillman D, Smyth J, Christian L: Internet, Mail and Mixed- Mode Surveys: The Tailored Design Method. 3rd ed. John Wiley & Sons, Inc., Hoboken, NJ, 2009.
  24. Aday L, Cornelius L, Lewellyn J: Designing and Con- ducting Health Surveys: A Comprehensive Guide. Jossey- Bass, San Francisco, CA, 2006.
  25. American Academy of Pediatrics Committee on Bioethics and Committee on Hospital Care: Palliative Care for Children. Pediatrics 2000;106:351-357.
  26. Weigl M, Schneider A, Hoffmann F AP: Work stress, burnout, and perceived quality of care: A cross-sectional study among hospital pediatricians. Eur J Pediatr 2015; 174:1237-1246.
  27. Shanafelt T, Gradishar W, Kosty M, et al.: Burnout and career satisfaction among US oncologists. J Clin Oncol 2014;32:678-686.
  28. Meert KL, Eggly S, Berg RA, et al.: Feasibility and per- ceived benefits of a framework for physician-parent follow- up meetings after a child's death in the PICU. Crit Care Med 2014;42:148-157.
  29. Wu K, Friderici J, Goff S: The impact of a palliative care team on residents' experiences and comfort levels with pediatric palliative care. J Pall Med 2014;17:80-84.
  30. Eggly S, Meert KL, Berger J, et al.: A Framework for conducting follow-up meetings with parents after a child's death in the pediatric intensive care unit. Pediatr Crit Care Med 2011;12:147-152.
  31. McClafferty H, Brown O: Physician health and wellness. Pediatrics 2014;134:830-835.
  32. Shanafelt T, Raymond M, Horn L, et al.: Oncology fellows' career plans, expectations, and well-being: Do fellows know what they are getting into? J Clin Oncol 2014;32: 2991-2997.
  33. VanGeest J, Johnson T, Welch V: Methodologies for im- proving response rates in surveys of physicians: A sys- tematic review. Eval Heal Prof 2007;30:303-321. Address correspondence to: Holly Lynn Spraker-Perlman, MD, MS Division of Pediatric Hematology-Oncology University of Utah
  34. North Mario Capecchi Drive, Suite 4100 Salt Lake City, UT 84113
  35. E-mail: holly.perlman@imail.org