Clinician Confidence and Comfort in Providing Perinatal Palliative Care

摘要

Objective: To analyze and report the differences in perceptions of physicians and advance practice nurses, their comfort in providing and referring neonatal patients to perinatal palliative care (PPC), and their confidence in delivering such care. Design: A cross-sectional survey design using the Perinatal Palliative Care Perceptions and Barriers Scale. Setting: A survey was administered using Qualtrics, a Web-based tool. Recruitment was completed via e-mail invitation and list servs. Participants: Physicians (n = 66), advance practice nurses (n = 146), and other clinicians (n = 90). Methods: t test and Mann-Whitney U were used to examine differences in clinician perspectives, comfort, and confidence in delivering PPC. Hierarchical multiple regression was used to test the hypothesis that clinician perceptions, barriers to PPC, years in clinician practice, referral comfort, and personal comfort and case history explain variation in confidence. Results: Physicians and nurses have fundamentally similar perspectives but report significant differences in their comfort with providing and referring patients to PPC and their confidence in delivering such care. There was a significant regression equation with an overall R2 of .56 explained variation in confidence. Conclusion: Palliative care involves physicians and nurses making unique and positively synergistic contributions to the care of families expecting an infant with a life-limiting diagnosis. Clinicians share ethical perspectives regarding PPC and are positioned to collaboratively develop PPC programs. Barriers to PPC delivery exist and clinicians can benefit from interventions aimed at modifying practice environments. Supportive interventions and educational initiatives may increase clinician comfort and confidence with palliative care delivery.