1. Care in a Child’s Last Hours
PI: Dr. Kenneth Pituch, MD
PI: Dr. James Azim, MD
Research Assistant: Melanie Halsey
Purposes / Objectives
Methods
Preliminary Results (4-1-15)
References
Introduction
Implications/Further Directions
• Many healthcare professionals are trained in end-of-life
care through Pediatric Advanced Life Support (PALS).
However, this training may not be effective in cases where
death is anticipated.
• A new training module has been administered to over 350
professionals since 2010 by Mott’s Pediatric Palliative Care
Team to help prepare professionals when death is
anticipated.
• To determine whether advanced EOL care training,
facilitated by Mott’s Pediatric Palliative Care Team, (1) can
help professionals reduce their own stress and anxiety,
and (2) positively impact end-of-life care delivered by
health care professionals.
• Likert scale surveys were sent to professionals involved in
care of a dying child.
• Demographic information was collected- profession, as well
as types of previous end-of-life care training.
• These scales assessed the degree of agreement that
participation in advanced EOL training and/or PALS training
(1) helped them to participate more effectively in the care of
dying child and (2) reduced anxiety or stress in the delivery
of end-of-life care.
• Over 321 survey responses have been collected over the
span of 58 deaths and 776 requests. There were 5-31 total
requests per death. Response rate __41.4____%
1. Data suggests that EOL care training may provide as a
useful adjunct to PALS training when caring for children
in their last hours of life.
2. Providing additional training may improve care for
patients and their families, as well as the healthcare
officials who work with them.
3. Further research may be needed in other hospitals in
order to determine the need of additional training in
end-of-life care.
0% 50% 100%
helped me to
participate more
effectively in the
care of dying child
reduced anxiety or
stress in the
delivery of end-of-
life care.
My Participation in a Pediatric End-of-Life Care
training workshop facilitated by Mott Pediatric
Palliative Care Team…
Strongly
Disagree or
Disagree
Agree or
Strongly
Agree
0% 50% 100%
helped me to
participate more
effectively in the
care of dying child
reduced anxiety or
stress in the
delivery of end-of-
life care.
My participation in Pediatric Advanced Life
Support (PALS) training…
Strongly
Disagree or
Disagree
Agree or
Strongly Agree
0
5
10
15
20
25
30
35
40
Percent
Type of Provider
Distribution of Responses
Abstract
Background: Children’s hospital professionals receive standardized training in Pediatric
Advanced Life Support (PALS) but they are not formally trained in the provision of end-of-life
care where death is anticipated. To address this training gap, the Palliative Care Team at
C.S. Mott Children’s Hospital in Ann Arbor, MI developed a series of training modules and
workshops for the provision of end-of-life (EOL) care and have trained over 350
professionals since 2010.
Objectives: To assess whether receiving advanced EOL care training can help caregivers
provide more effective care for a dying patient and reduce their own stress and anxiety as
they deliver that care.
Methods: Likert scale surveys were sent to professionals involved in care of a dying child to
assess the degree of agreement that participation in advanced EOL training or PALS training
(1) helped them to participate more effectively in the care of dying child and (2) reduced
anxiety or stress in the delivery of end-of-life care.
Results (as of April 1st, 2015, still preliminary): Three hundred and twenty-one responses
have been collected (mostly doctors and nurses) over the course of fifty-eight deaths. Forty-
five percent of respondents disagreed or strongly disagreed that PALS training helped them
participate more effectively in the patient's care; forty-seven percent disagreed or strongly
disagreed that PALS training reduced their anxiety or stress. Eighty-nine percent of
respondents who had received EOL training agreed or strongly agreed that EOL training not
only helped them participate more effectively, but also reduced their anxiety or stress.
Impact on Practice/Implications: Training in advanced end-of-life care may be a useful
adjunct to PALS training in preparing pediatric professionals caring for children in their last
hours of life.
1. KJ Lee, CY Dupree, Staff experiences with end-of-life care in the pediatric
intensive care unit, J Palliative Medicine 11((7) 986-990, Sep. 2008
2. MJ Sheetz, MA Sontag-Bowman, Pediatric palliative care: an assessment of
physicians’ confidence in skills, desire for training, and willingness to refer for end-of-
life care, American Journal of Hospice and Palliative Medicine 25(2) 100-105, April-
May 2008
3. N Embriaco et al, Burnout syndrome among critical care healthcare workers,
Current Opinion in Critical Care 13:482-488, 2007
PA=Physician Assistant
NP=Nurse Practitioner
Pediatric EOL
training
workshop
facilitated by
the Mott
Pediatric
Palliative Care
Team, 79
ICU End-of-
Life Care case-
based
discussion,
124
PALS training,
143
Other, 45
No training, 68
Types of Training Completed