112: Paediatric Palliative Care in Canada: A National Survey of Paediatricians
Notice bibliographique
Résumé
Paediatric palliative care (PPC) focuses on achieving the best possible quality of life for children with life-threatening conditions and their families. To achieve this goal, paediatricians have to identify the needs of children with life-threatening conditions and provide care that responds adequately to suffering. This study investigates how paediatricians define PPC and their perception of the needs of children with life-limiting diseases. Cross-sectional survey of a sample of 2485 Canadian paediatric specialists and subspecialists. The Canadian Paediatric Surveillance Program (CPSP) provided the sampling frame and survey management. The survey was distributed electronically and in hard copy formats. Of 420 respondents (17% response rate), 219 (52%) cared for patient with PPC needs in the month prior to the survey distribution. Most paediatricians (78%) offered a definition that included, but was not limited to end-of-life, 17% defined it as end-of-life only, and 5% did not know. A majority (58%) agreed with the four broad groups of children who would benefit from PPC (progressive conditions in which treatment is exclusively palliative after diagnosis, conditions for which curative treatment is possible but may fail, conditions requiring intensive long-term treatment aimed at maintaining quality of life, and conditions involving severe, non-progressive disability, causing extreme vulnerability to health complications). Of a total of 1127 children with PPC needs, paediatricians cared directly for 861 (76%) without referral to a PPC team. Most frequent PPC needs in these children were: support for family (94%); coordination of services in the community (88%); physical symptom management (84%); respite care (81%); support for child (80%); and care at the time of death (78%). Only 48% felt that their patients were receiving all the services needed. Although paediatricians overwhelmingly cited the need for many types of PPC services, only 35% had referred their patients to PPC and 18% did not have access to PPC team. Canadian paediatricians care for a large number of children with PPC needs. Despite recommendations to refer children to palliative care early in the course of illness, many paediatricians define palliative care as similar to hospice care. Paediatricians need to become familiar and comfortable with the provision of palliative care to children. Residency training and continuing education programs should include topics such as palliative medicine, communication skills, grief and loss, managing prognostic uncertainty, and decisions to forgo life-sustaining medical treatment, spiritual dimensions of life and illness.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».