A Structured End-of-Life Curriculum for Neonatal–Perinatal Postdoctoral Fellows

Abstract

Death in tertiary care neonatal intensive care units is a common occurrence. Despite recent advances in pediatric palliative education, evidence indicates that physicians are poorly prepared to care for dying infants and their families. Numerous organizations recommend increased training in palliative and end-of-life care for pediatric physicians. The purpose of this study is to develop a structured end-of-life curriculum for neonatal-perinatal postdoctoral fellows based on previously established principles and curricular guidelines on end-of-life care in the pediatric setting. Results demonstrate statistically significant curriculum effectiveness in increasing fellow knowledge regarding patient qualification for comfort care and withdrawal of support (P = .03). Although not statistically significant, results suggest the curriculum may have improved fellows' knowledge of appropriate end-of-life medical management, comfort with addressing the family, and patient pain assessment and control.

A Systematic Review of Training in Symptom Management in Palliative Care Within Postgraduate Medical Curriculums

“…55 The dedicated time in the speciality is probably of most relevance, though this strategy requires a well-coordinated schedule taking into account other parallel rotations, and sometimes, extra-hours work for trainees and faculty. 56 Despite possible benefits of simulation training 57,58 , this strategy was not found in any studies of this review. For instance, one recent controlled study compared simulation training to didactic education on communication skills and difficult discussions, but with some contents on symptom management, in paediatric fellows.…”

Pediatric Palliative Care in Infants and Neonates

“…For the pediatric PC specialist familiar with neonatal-perinatal care, this will not necessarily pose concerns. However, for those unfamiliar with neonatal-perinatal care (e.g., a pediatric oncologist who has been trained in PC, or a family physician now boarded in Hospice and Palliative Medicine) there may be a learning curve to ramp up capabilities to address the often unique aspects of pregnancy and childbirth complicated by life-limiting conditions [ 37 , 38 , 39 ].…”

“…These developments will impose the need for expanded perinatal counseling and open doors for PC clinicians to join neonatologists, geneticists, and maternal-fetal medicine specialists in contributing to perinatal and neonatal decision-making. Already, we see the possibility of expanded genome-wide newborn screening being proposed in the care of all newborns, and even if this is constrained to symptom-driven circumstances, the need to address prognostic uncertainty will call upon the superlative communication skills of trained and informed neonatologists and PC clinicians [ 37 , 38 , 39 , 44 ].…”

“…Given the longstanding interdisciplinary nature of the care team in the NICU, unit-specific neonatal nurse practitioners who may be PC champions, respiratory therapists, perinatal social workers, nurses, and others can work with chaplains, psychologists, and child-life specialists to create NICU-PC teams that address unit needs with input and assistance from pediatric PC specialists elsewhere in the hospital. Together these complimentary and concurrent teams can see to patients, family, and staff needs [ 19 , 37 , 38 , 39 , 44 , 45 ].…”

Outcomes and factors influencing care decisions in life-threatening fetal and neonatal anomalies

“…Asplin's group in Sweden found that women decided to terminate a pregnancy based on the severity of the malformation. They also indicated that socioeconomic considerations and the doctor at the fetal care unit influenced the decision(20).Other advances in perinatal palliative care have involved the development of a structured end-of-life curriculum for neonatal-perinatal postdoctoral fellows(21) and studying the various perceptions of health care workers regarding perinatal palliative care(22)(23)(24).…”