addresses the unique educational, fiscal, clinical, regulatory, philosophical, and ethical needs of a pediatric hospice population. Similarly, although organizations dedicated to pediatric care have work groups devoted to end-of-life care (e.g., the Children’s Oncology Group [COG], the American Academy of Pediatrics [AAP], and Children’s Hospice International) and continue to advocate for the needs of dying children, unifying, collaborative national efforts to bring provider education to the forefront do not exist.

Finally, there are only a handful of quality textbooks targeted to pediatric palliative care, and the subject is underrepresented in the classic adult textbooks such as Supportive Care in Oncology (Weisman, 1998) or the Oxford Textbook of Palliative Medicine (Doyle et al., 1998). Examples of essential pediatric texts include Hospice Care for Children (Armstrong-Dailey and Goltzer, 1993), Care of the Dying Child (Goldman, 1994), and Cancer Pain Relief and Palliative Care in Children (WHO, 1998) as well as two explorations of the more spiritual aspects of childhood death, The Private Lives of Dying Children (Bluebond-Langer, 1978) and Armfuls of Time (Sourkes, 1995).

Next Steps
  • Develop content for pediatric end-of-life care curricula in medical, nursing, chaplaincy, and social work training programs. The challenges facing creators of curricula include defining educational objectives; outlining the content of training; selecting teaching methods; exploring personal attitudes toward death, dying, and bereavement; promoting interdisciplinary collaboration; evaluating training; and defining the role and function of educators in pediatric palliative care (see Papadatou, 1997, for a discussion of challenges in creating a pediatric palliative care course).

  • Develop curricula with both traditional and alternative teaching methods. Standard didactic approaches are the tradition in many post-secondary education programs, but these approaches do not optimally address the emotional and psychological needs of students in a complex field such as pediatric palliative care. Alternative methods such as small group discussion, role playing, experiential learning by partnering with mentors, supervised clinical practice, and/or self-directed on-line learning may better suit training at all levels. Small studies have demonstrated the efficacy of nontraditional learning methods, including those derived from the psychology world, in altering attitudes of students regarding end-of-life issues (Razavi et al., 1988, 1991). At the Children’s Hospital of Philadelphia, a pilot study is under way to explore the role of an intensive, brief cognitive-behavioral intervention for staff in changing values and beliefs about pediatric palliative care.

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