Rushton, C. H., Reder, E., Hall, B., Comello, K., Sellers, D. E., & Hutton, N. (2006). Journal of Palliative Medicine, 9, 922-933.

An interdisciplinary committee at Johns Hopkins Children's Center began their initiative to improve the quality of care given to dying children by assessing the knowledge, attitudes, beliefs, and concerns of healthcare professionals regarding end-of-life care. Healthcare professionals reported significant levels of distress and many believed that the care provided was not optimal. The committee then initiated a quality improvement program of professional education and support that consisted of four interdisciplinary activities: a forum for networking and education, palliative care rounds, palliative care conferences, and bereavement debriefing sessions. The program was based on an empowerment, facilitation model and was designed to help healthcare professionals (a) increase their competence and confidence in providing pediatric palliative care, (b) increase their ability to manage responses of grief, and (c) restore and maintain their sense of professional integrity. This article reported the feasibility and utilization, content, and participants' views of usefulness. One hundred one sessions were conducted for 950 participants. All four activities were positively evaluated. The authors concluded, "A comprehensive approach that includes clinical skills, psychosocial support, meaning making, and offering opportunities to integrate palliative and end-of-life knowledge and skills is critical to meeting the diverse needs of the interdisciplinary health care team" (p. 930). Although additional evaluation is needed to evaluate the impact of this program on the quality of palliative care provided to children and their families, a program such as this may be helpful in educating and supporting healthcare professionals in providing end-of-life care and can be applied in diverse pediatric healthcare settings.

Maureen Heaman