title: Advance Care Discussions: Pediatric Clinician Preparedness and Practices.
abstract: BACKGROUND
  Few data exist regarding clinician preparedness to participate in advance care discussions (ACD) and the practices surrounding these discussions for children with life-threatening conditions.
  
  
  OBJECTIVE
  We sought to understand pediatric clinician preparedness to participate in ACD and the practices surrounding these discussions.
  
  
  METHODS
  A survey was administered to assess clinician attitudes and behaviors regarding ACD.
  
  
  RESULTS
  Two hundred sixty-six clinicians (107 physicians and 159 nurses) responded to the survey (response rate 53.6%). Seventy-five percent of clinicians felt prepared to participate in ACD. Most clinicians believed they were prepared to express empathy (98.8%), discuss goals of care for an adolescent patient (90.3%), and elicit a parent's hopes (90.3%). Conversely, several felt unprepared to discuss resuscitation status with school-aged (59.7%) and adolescent (48.5%) patients and to conduct a family conference (39.5%). The most frequent topics addressed were: parents' understanding of the patient's illness (75.5%), primary goals of the parent (75.1%), and the parents' understanding of prognosis (71.1%). Conversely, the topics least commonly discussed were as follows: belief system of the patient/family (22.0%), patient's hopes (21.2%), and the patient's perceptions of his/her quality of life (19.8%). Notably, 40% of clinicians believe that caring for patients with poor prognoses is depressing, and this was more common among less-experienced clinicians (P = 0.048).
  
  
  CONCLUSIONS
  Many clinicians believe they are prepared to participate in ACD, but practices are not consistent with expert recommendations for optimal ACD. Educational interventions aimed at improving clinician knowledge, attitudes, and behavior, and greater clinician support may enhance health care provider ACD preparedness and skills.
authors.affiliation: Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. Electronic address: amy.sanderson@childrens.harvard.edu.
authors.forename: Amy
authors.initials: A
authors.lastname: Sanderson
authors.affiliation: Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Amber M
authors.initials: AM
authors.lastname: Hall
authors.affiliation: Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA; Division of Pediatric Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Wolfe
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D000072222:Nurses, Pediatric / Q000523:psychology*; D010290:Parents / Q000523:psychology; D010372:Pediatrics / Q000379:methods*; D010820:Physicians / Q000523:psychology*; D013727:Terminal Care / Q000379:methods* / Q000523:psychology; D013997:Time Factors
keywords: Advance care discussion; end-of-life; pediatric palliative care