Training in pediatric palliative care in Italy: still much to do (original) (raw)
Related papers
Barriers to the development of pediatric palliative care in Italy
Annali dell'Istituto superiore di sanita
In recent years the emergence of new types of patient, clinical situations, technological frontiers and "health" objectives have changed considerably the needs of ill children, this also concerns pediatric palliative care (PPC). In Italy, despite the introduction of legislation (Law 38/2010) stipulating the right of children and families to access appropriate services for pain control and pediatric palliative care, the availability of these services is still limited. The aim of this study is to highlight, through a review of the existing data and published literature, the critical issues that obstacle the planning and development of PPC services in Italy. Four main areas identified were: socio-cultural setting; types of patients and nature of diseases requiring PPC; training for PPC providers; regulatory and political issues. This type of analysis can provide the rational for advancing proposals and developing supportive, corrective and implementation strategies.
Healthcare
There is a lack of highly reliable tools evaluating healthcare professionals’ competences on Pediatric Palliative Care (PPC) and Pain Therapy (PT). The aim of this study is to document the development of an online questionnaire to assess Perceived, Wished and Actual Knowledge of healthcare workers on PPC/PT. The tool was built on the basis of the Italian Society for Palliative Care PPC Core Curriculum (CC) for physicians, nurses and psychologists. Face validity, internal consistency and the underlying structure were evaluated after a field testing in a referral hospital, Friuli-Venezia Giulia, Italy. One hundred five respondents completed the questionnaire. High internal consistency for both scales of Perceived and Wished Knowledge was found (α = 0.95 and α = 0.94, respectively). Psychologists reported higher levels of self-Perceived skills on the psychosocial needs of the child and family at the end of life (p = 0.006), mourning (p = 0.003) and ethics and deontology in PT/PC (p = 0...
An estimation of the number of children requiring pediatric palliative care in Italy
Italian Journal of Pediatrics
Background Pediatric palliative care (PPC) addresses the physical and psychological needs of children suffering from life-limiting diseases. To define prevention and educational plans and to properly allocate resources, a precise estimation of the PPC burden is required. Objectives To estimate the current number of children requiring PPC in Italy, useful to assist policy-makers and healthcare bodies in the organization and allocation of PPC resources. Methods Literature data, The Global Atlas of Palliative Care at the End of Life and Italian national databases have been consulted. Results According to our estimation, at present, a total of 20,540–32,864 children in Italy require PPC (34–54 children/100,000 inhabitants) of whom 18 children/100,000 inhabitants require specialized PPC. Conclusions The present work is a fundamental tool to be used by the institutions, the local networks of PPC and the health programmers when formulating organizational models and care plans consistent wi...
2015
tiziana.ferrante@uniroma1.it Abstract. La qualita del S.S.N. si misura sull'efficienza dei servizi territoriali e sulla loro capacita di rispondere ai nuovi bisogni emergenti della popolazione. Fra questi le cure palliative trovano negli hospice le necessarie strutture di rife- rimento. In Italia, numerosi sono quelli dedicati agli adulti, mentre solo uno (a Padova) risponde a specifici e differenti bisogni dei bambini. C'e ora la possibilita di realizzare un secondo hospice pediatrico a Genova gra- zie alla collaborazione tra l'Istituto Gaslini e la Fondazione Maruzza Lefebvre D'Ovidio Onlus; qui si presenta l'ipotesi progettuale di ristrutturazione di parte di un padiglione del Gaslini, frutto di una ricerca e di modalita operative che hanno privilegiato la partecipazione di operatori con articolate competenze disciplinari. Parole chiave: Edilizia sociosanitaria, Hospice pediatrico, Progettazione La riduzione dello standard po- sti letto ospedalieri 3/1.000 ab....
Italian Journal of Pediatrics
Background: The definition of the eligibility criteria of newborn, infant, child, or adolescent patients for palliative care (PC) is complicated by the fact that these patients generally present with very specific case histories that make it inadvisable to directly adopt existing PC protocols devised for adult patients. Thus, the goal of this paper is to define a standard set of criteria for establishing pediatric palliative care (PPC) eligibility. Methods: The method adopted was that of the consensus conference. According to the guidelines issued by the Higher Institute of Health, the Board of the Italian Society for Palliative Care (i.e. steering committee) appointed a multidisciplinary group of eight health care professionals (i.e. doctors, nurses and psychologists) who worked from May 2014 to February 2016 to reach a consensus over PPC eligibility. This panel of relevant experts redacted a report summarizing all available scientific information concerning PPC, which was then submitted to the attention of a multidisciplinary jury composed of specialists and non-specialists of the field. The document thus produced was subsequently reviewed by an extended team of experts. Results: The consensus conference drafted a final document determining the guidelines for PPC eligibility of newborns, infants, children, and adolescents suffering from either oncological or non-oncological diseases. Conclusions: This report provides health care providers with practical guidelines on how to define the eligibility of pediatric patients for PPC. Given the current situation in Italy, these guidelines will be instrumental in assisting the implementation of adequate generalist and specialist PPC services as well as in helping policymakers draft and implement national legislation pertaining to PPC.
Background. There is a lack of validated tools to evaluate the healthcare professionals’ competences on Pediatric Palliative Care (PPC) and Pain Therapy (PT). The aim of this study is to document the development and validation of a questionnaire to assess perceived, wished and actual knowledge of healthcare workers on PPC/PT. Methods. On the basis of the Italian Society for Palliative Care PPC Core Curriculum (CC) for physicians, nurses and psychologists, an online questionnaire was developed in four sequential steps. Construct validity, coherence of the instrument, and educational needs of participants were assessed after a field testing in a referral hospital, Northeast Italy. Results. One-hundred-five respondents completed the online questionnaire, from January 1st to July 31th 2019. Findings showed high internal consistency for both scales of perceived and wished knowledge (⍺=0.95 and ⍺=0.94, respectively). Psychologists reported higher levels of self-perceived skills on psychos...
2019
Background: There is lack of a standardized residency curriculum for the emerging field of Pediatric Palliative Care (PPC). Available evidence suggests that few resident physicians acquire the requisite knowledge and essential skills needed to develop competency in PPC during their postgraduate education and training [1]. Methods: A pediatric end-of-life resident physician assessment survey was utilized to evaluate self-reported competence and concerns / interests about PPC. Results: Self-reported competence increased with each year of residency training. With regards to their communication skills, only 40 % of the residents felt competent to perform with minimal supervision or independently as compared to 65 % when it comes to their symptoms management skills. Residents also felt less prepared with the psychosocial aspects of caring for pediatric patients (e.g., when to initiate hospice referral, communicating to the family the shift from curative to comfort care measures, discussing donotresuscitate orders, conducting family conferences for end-of-life decisions, using adjuvant analgesics, and giving bad news to the patient or family members). Conclusion: The survey results showed differing levels of competence among pediatric interns and residents. The feedback from this study further supports that not only is PPC in postgraduate medical training necessary, it should also address the full experience of the terminally-ill pediatric patient, encompassing both physical and non-physical (psychosocial) aspects.
Establishing a Pediatric Palliative care team in an Argentinian Hospital
European Journal of Palliative Care
P alliative medicine emerged as a specialty 40 years ago. As is the case for all paediatric specialties, palliative medicine for children cannot be simply replicated from the adult model, but must be developed taking into account the practice and experience of paediatricians. Palliative care for children and young people with life-threatening or life-limiting conditions embraces physical, cognitive, emotional, social and spiritual aspects. Its goal is to enhance the patient's quality of life and to help the family, by managing symptoms and providing psychosocial care, respite care and bereavement support. Paediatric palliative care has developed from the hospice philosophy to offer a complement or alternative to curative treatment in children with advanced, complex and progressive disease, and to provide care for those in the terminal phase. Paediatric palliative care should be provided from the time of diagnosis and during the whole disease trajectory; it may need to be provide...