title: Impact of a multifaceted education program on implementing a pediatric palliative care guideline: a pilot study.
abstract: BACKGROUND
  A national clinical practice guideline for pediatric palliative care was published in 2013. So far there are only few reports available on whether an educational program fosters compliance with such a guideline implementation. We aimed to test the effect of the education program on actual compliance as well as documentation of compliance to the guideline.
  
  
  METHODS
  We performed a prospective study with pre- and post-intervention evaluation on compliance to the guideline of the nurse specialists of a pediatric palliative care team for case management at a children's university hospital. Eleven quality indicators were selected from 192 recommendations from the pediatric palliative care guideline, based on frequency, measurability and relevance. The multifaceted education program included e-learning and an interactive educational meeting. Four e-learning modules addressed 19 patient cases on symptoms, diagnostics and treatment, and a chart-documentation exercise. During the interactive educational meeting patient cases were discussed on how to use the guideline. Documentation of compliance to the guideline in the web-based patient-charts as well as actual compliance to the guideline through weekly web-based parent reports was measured before and after completion of the e-learning.
  
  
  RESULTS
  Eleven quality indicators were selected. The educational program did not result in significant improvement in compliance for any of these indicators. The indicators "treatment of nausea", "pain medications two steps ahead" and "pain medication for 48 h present", measured through parent reports, scored a compliance beyond 80 % before and after e-learning. The remaining indicators measuring compliance, as well as six indicators measuring documentation by chart review, showed a compliance below 80 % before and after e-learning.
  
  
  CONCLUSIONS
  The multifaceted education program did not lead to improvement in documentation of compliance to the guideline. Parent reported outcome revealed better performance and might be the more adequate assessment tool for future studies.
authors.affiliation: Emma Children's Hospital, Academic Medical Centre, Pediatric Oncology F8 Zuid, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. c.t.jagt@amc.nl.
authors.forename: Charissa Thari
authors.initials: CT
authors.lastname: Jagt-van Kampen
authors.affiliation: Emma Children's Hospital, Academic Medical Centre, Pediatric Oncology F8 Zuid, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
authors.forename: Leontien C M
authors.initials: LC
authors.lastname: Kremer
authors.affiliation: Universitair Medisch Centrum Groningen, Beatrix Kinderziekenhuis (code CA 72), Postbus 30.001, 9700, RB, Groningen, The Netherlands.
authors.forename: A A Eduard
authors.initials: AA
authors.lastname: Verhagen
authors.affiliation: Emma Children's Hospital, Academic Medical Centre, Pediatric Oncology F8 Zuid, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
authors.forename: Antoinette Y N
authors.initials: AY
authors.lastname: Schouten-van Meeteren
mesh_terms: D002648:Child; D004502:Education, Medical, Continuing / Q000379:methods; D019983:Guideline Adherence; D006801:Humans; D010166:Palliative Care / Q000592:standards; D065126:Palliative Medicine / Q000193:education* / Q000592:standards; D010372:Pediatrics / Q000193:education* / Q000592:standards; D010865:Pilot Projects; D011446:Prospective Studies; D019984:Quality Indicators, Health Care