A Workshop in End‐of‐Life Care Increases Confidence in Children's Hospital Staff Members Who Care for Dying Children

Background:

In 2010, our tertiary‐care children's teaching hospital funded a pilot project to deliver workshops to interdisciplinary groups of pediatric house officers, fellows, nurses, and therapists who may be involved in caring for children in the hospital at end of life (EOL). Interactive video‐based workshops were developed for caring for a neonate with a fatal anomaly, a child with terminal cancer, and an adolescent with end‐stage cystic fibrosis. Workshops were conducted with both 142 hospital staff between 2010 and 2012 and 25 international pediatric house officers, fellows, and attendings at Pediatric Academic Societies in 2012.

Methods:

Following a 90‐minute workshop, participants completed a 16‐item retrospective pre‐/posttest to assess confidence in knowledge and skill domains important in caring for dying children. Response options ranged from (1) need further instruction, (2) perform with close supervision, (3) perform with backup available, to (4) perform independently.

Results:

Ninety‐one hospital staff members (67%) and 19 conference participants (76%) completed pre/post self‐assessments. Mean delta score increases were >0.5 for 14 of the 16 domains for hospital staff and for 12 of the 16 domains for conference participants, who had higher mean prescores. Prior to the workshop, participants felt most confident in explaining the distinction between curative and comfort care, discussing do‐not‐attempt‐resuscitation orders, and assessing pain (mean prescores > 3.02). The greatest increase in confidence after the workshop was in providing EOL anticipatory guidance, discussing what happens after death, assessing and managing nonpain symptoms, and pronouncing death (delta scores, 0.73–0.92). Participants initially felt least confident in discussing EOL decisions in a family conference with a competent teenager and in applying ethics to withdrawal of care decisions (mean prescores < 2.52); however confidence increased significantly for each of these skills after the workshop (delta score > 0.5).

Conclusions:

The interdisciplinary workshops provide a venue to teach skills in caring for a dying child, as well as ease hospital staff discomfort in discussing complex EOL decisions. The findings have been replicated in an international population with a higher baseline level of training.