title: Effect of a pediatric palliative care program on nurses' referral preferences.
abstract: OBJECTIVE
  Florida was the first state to develop and implement a publicly funded pediatric palliative care program, which provides supportive care services to children and families from the point of diagnosis onward. Nurses employed by the Florida Department of Health, Children's Medical Services Network (CMSN) play an important role in this program as they are charged with identifying children with life-limiting illnesses in their caseloads for referral to the program. This study aims to estimate the differtences in referral preferences of nurses who work in Partners in Care: Together for Kids (PIC:TFK) program areas versus nurses who work in non-PIC:TFK areas.
  
  
  METHODS
  Mail and Web-based surveys were conducted with 279 nurses, 141 of whom work in a PIC:TFK site and 138 did not.
  
  
  RESULTS
  Results of the multivariate analyses suggest that few significant differences exist in the nurse's preferences to refer children to pediatric palliative care; however, there were significant differences in the preferred timing of referral. Nurses who work in an PIC:TFK area were 3.7 to 10.4 times as likely as nurses who do not work in a PIC:TFK area to refer children prior to the end of life.
  
  
  CONCLUSIONS
  Our study provides evidence that nurses who have experience with a pediatric palliative care program are more likely to refer children to programs before the end of life. While our study results are encouraging, they also suggest that as the PIC:TFK program expands nurse training will be essential for equitable and appropriate referrals across a diverse set of illnesses.
authors.affiliation: Department of Epidemiology, University of Florida, Gainesville, Florida 32604, USA. cak@ichp.ufl.edu
authors.forename: Caprice A
authors.initials: CA
authors.lastname: Knapp
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Madden
authors.forename: Hua
authors.initials: H
authors.lastname: Wang
authors.forename: Kristin
authors.initials: K
authors.lastname: Kassing
authors.forename: Charlotte M
authors.initials: CM
authors.lastname: Curtis
authors.forename: Phyllis J
authors.initials: PJ
authors.lastname: Sloyer
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Shenkman
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D010166:Palliative Care / Q000191:economics / Q000379:methods*; D010346:Patient Care Management / Q000379:methods / Q000592:standards; D010371:Pediatric Nursing / Q000379:methods*; D012017:Referral and Consultation; D014481:United States; D055815:Young Adult