What are Palliative Care Physicians for Adults Taught on Palliative Care for Children? Paediatric Aspects in Palliative Care Curricula for Adults

Abstract

Background: Children suffering from life limiting diseases are frequently cared for by adult palliative care teams due to missing paediatric structures in that field. However it is questionable whether palliative care curricula for physicians comprehensively cover issues of paediatric palliative care (PaedPC).

Aim: To identify all PaedPC issues included in inter-professional or medical palliative care curricula (PCC) and to evaluate the breadth and quality of PaedPC issues covered in these curricula.

Design: Inter-professional or medical palliative care curricula (PCC) were identified by an extensive literature review in German and English using the search-engines Google as well as Medline, MedPilot and Pubmed.

Results: Worldwide 30 PCC were identified, with only 15 curricula mentioning any PaedPC issues. Of those 15 curricula, up to 22 PaedPC topics were highlighted in each. In 10 or more PaedPC following topics were highlighted: grief and bereavement in family, parents and siblings; communication with children; paediatric malignancies; pain management in PPC and pharmacology. In the majority of PCC curricula where PaedPC issues were identified the following topics were mentioned- grief and bereavement in the family, parents and siblings, communication with children, paediatric malignancies, paediatric pain management and pharmacology.

Conclusions: The variability of inclusion of PaedPC issues and the lack of depth and standardisation of knowledge, skills and attitudes in PaedPC issues included in PCC curricula is not sufficient to guide adult palliative care physicians in their clinical work with children suffering from life limiting diseases.

Zusammenfassung

Hintergrund: Aufgrund unzureichender palliativmedizinischer Versorgungsstrukturen speziell für Kinder, werden diese oft von Palliativmedizinern für Erwachsene versorgt. Es ist unklar, ob die palliativmedizinische Weiterbildung diese Ärzte hierfür ausreichend vorbereitet.

Ziel: Ziel der vorliegenden Untersuchung ist die Identifikation und Analyse von Curricula für ärztliche und multiprofessionelle Erwachsenen-Palliativmedizin in Bezug auf pädiatrische Inhalte.

Methode: Medline, Medpilot und Google wurden nach Curricula für die Erwachsenen-Palliativversorgung (ärztlich und interprofessionell) in englischer und deutscher Sprache durchsucht.

Ergebnisse: Weltweit konnten 30 Curricula identifiziert werden. Davon enthalten 15 Curricula auch pädiatrische Inhalte. Maximal werden in einem Curriculum 22 verschiedene pädiatrisch-palliativmedizinische Aspekte genannt. Folgende Aspekte waren in mehr als 10 (> 33%) der Curricula enthalten: Abschied und Trauer bei Eltern und Geschwistern, Kommunikation mit Kindern, Tumorerkrankungen bei Kindern, Schmerztherapie in der Kinderpalliativmedizin sowie pädiatrische Pharmakologie.

Schlussfolgerung: In den Curricula für die Erwachsenen-Palliativversorgung sind pädiatrische Themen weder in ausreichendem Umfang noch in standardisierter Form enthalten. Dies wird den Anforderungen nicht gerecht, die an Wissen, Fertigkeiten und Haltung der Erwachsenen-Palliativmediziner zur Versorgung von Kindern mit lebenslimitierenden Erkrankungen gestellt werden. Stehen spezialisierte Strukturen in Ausbildung und Versorgung nicht zur Verfügung, sollten pädiatrische Inhalte standardisiert und konsequent in die Ausbildung von Erwachsenen-Palliativmedizinern integriert werden.

Key words

palliative Care - end-of-life-care - curriculum - postgraduate education

Schlüsselwörter

Palliativmedizin - Pädiatrie - Ausbildung - Curriculum - Weiterbildung

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