Perceptions of Palliative Care Among Pediatricians

Pallimed's newest blogger, palliative care physician Dr. Lyle Fettig, writes about a survey in the journal Pediatrics that examines pediatricians' views of palliative care .

The study assesses how pediatricians define palliative care (and their view of the relationship of palliative care to hospice), what the pediatricians’ personal experience is with palliative care, and whether pediatricians agree with the Institute of Medicine’s recommendation to refer pediatric patients “before the end-of-life.” Pediatricians from Florida and California were surveyed. These states avail Medicaid waivers for pediatric palliative care services to eligible children. Of the 303 respondents, 76% were in private practice and the remainder practiced in an academic setting. Both generalists and subspecialists were included in the survey and there was an equal distribution of time in practice (with a third practicing less than ten years, a third between 11 and 20, and a third more than 20).

Of respondents, 41.9 % defined palliative care to be the same as hospice, 31.9% defined them differently, and the rest weren’t sure. Pediatricians at academic medical centers were twice as likely to define palliative care as different from hospice. About half of respondents had made a referral to a palliative care service previously, a percentage which wouldn’t have seemed high to me if they had surveyed pediatricians exclusively in academic settings, where I suspect most non-traumatic pediatric deaths occur. Since a significant minority equated palliative care with hospice (I'll call them "conflators"), I suspect that many of these referrals were to a hospice, not a palliative care program per se. Of those that had made referrals, the vast majority (83.7%) had referred two or fewer patients.