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Pediatric and Adult Cardiologists’ and Respirologists’ Referral Practices to Palliative Care

  • Natalie Jewitt
    Affiliations
    Pediatric Advanced Care Team (PACT), The Hospital for Sick Children, Toronto, Ontario, Canada (N.J., K.W.)

    Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada (N.J., K.W., R.A., C.T.M.)
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  • Kenneth Mah
    Affiliations
    Department of Supportive Care, University Health Network, Toronto, Ontario, Canada (K.M., C.Z., K.W.)
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  • Michael Bonares
    Affiliations
    Division of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.B.)

    Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (M.B., C.Z.)
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  • Kevin Weingarten
    Affiliations
    Pediatric Advanced Care Team (PACT), The Hospital for Sick Children, Toronto, Ontario, Canada (N.J., K.W.)

    Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada (N.J., K.W., R.A., C.T.M.)
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  • Heather Ross
    Affiliations
    Peter Munk Cardiac Centre, Department of Medicine, University of Toronto and University Health Network, Toronto, Ontario, Canada (H.R.)
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  • Reshma Amin
    Affiliations
    Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada (N.J., K.W., R.A., C.T.M.)

    Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada (R.A.)
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  • Conall Thomas Morgan
    Affiliations
    Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada (N.J., K.W., R.A., C.T.M.)

    Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada (C.T.M.)
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  • Camilla Zimmermann
    Affiliations
    Department of Supportive Care, University Health Network, Toronto, Ontario, Canada (K.M., C.Z., K.W.)

    Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (M.B., C.Z.)
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  • Kirsten Wentlandt
    Correspondence
    Address correspondence to: Kirsten Wentlandt MD, PhD, MHSc, UHN- Toronto General Hospital, 9NU- 925, 200 Elizabeth St, Toronto, Ontario M5G 2C4, Tel. 416 340 4800 ext 2674, Fax 416 340 4823.
    Affiliations
    Department of Supportive Care, University Health Network, Toronto, Ontario, Canada (K.M., C.Z., K.W.)

    Division of Palliative Care, Department of Community and Family Medicine, University of Toronto, Toronto, Ontario, Canada (K.W.)
    Search for articles by this author

      Abstract

      Context

      Children and adults with advanced cardiac or respiratory disease may benefit from specialized palliative care (SPC), but there has been little SPC research in this area.

      Objectives

      To explore pediatric cardiologists’ and respirologists’ (pediatric clinicians) beliefs about and referral practices to SPC and compare these results to adult cardiologists and respirologists (adult clinicians).

      Methods

      Pediatric and adult clinicians were sent a survey exploring SPC referral practices and beliefs. Responses were summarized with descriptive statistics. Pediatric and adult clinicians’ responses were compared using Pearson's chi-square test.

      Results

      The response rate was 56% (989/1759); 9% (87/989) were pediatric clinicians. Pediatric clinicians were more likely than adult clinicians to be female, work in an academic center, and experience fewer patient deaths (P<0.001). Pediatric clinicians reported better access to SPC clinical nurse specialists, spiritual care specialists and bereavement counselors (P<0.001), while adult clinicians reported better access to palliative care units (P<0.001). Pediatric clinicians referred to SPC earlier, while adult clinicians tended to refer after disease directed therapies were stopped (P<0.001). More than half of all clinicians felt patients had negative perceptions of the phrase “palliative care”. Although most clinicians were satisfied with SPC quality (73–82%), fewer adult clinicians were satisfied with SPC availability (74 vs. 47%; P<0.001). Fewer pediatric clinicians felt that SPC prioritized oncology patients (13 vs. 53%; P<0.001).

      Conclusion

      There are important differences between pediatric and adult clinicians’ beliefs about and referral practices to SPC. This may reflect unique features of pediatric diseases, provider characteristics, care philosophies, or service availability.

      Key Words

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