Palliative Care Education in Pediatric Cardiology Fellowships: A Survey of Program Directors

With advances in treatment options for severe congenital heart disease, there is a growing population of children and adults living with advanced heart disease, many of whom experience significant long-term comorbidities and uncertain disease trajectories. Although palliative care (PC) plays an integral role in the care of children with advanced heart disease, there is a lack of PC education in pediatric cardiology fellowship training. We distributed a cross-sectional survey to pediatric cardiology fellowship program directors (PDs) nationally (n = 58). Survey response rate was 48.3% (28/58). PDs reported PC didactic education in 71.4% (20/28) of programs, with 95% (19/20) reporting this education came from PC specialists, 35% (7/20) from pediatric cardiologists, 25% (5/20) from cardiac intensivists, and 10% (2/20) from general pediatric intensivists. Simulation was used by 10.7% (3/28) of programs. Only one program utilized online modules. Informal bedside teaching occurred in 92.9% (26/28) of programs, and dedicated PC rotations in 25% (7/28). Most programs endorsed annual formal didactics on various PC topics, although some topics were covered more frequently and some never covered by individual programs. Only 53.8% (14/26) of PDs were satisfied with the amount of PC education while 76.9% (20/26) were satisfied with the quality of PC education. Barriers included "too much other content to cover" (77%) and "lack of faculty expertise" (27%). A subset of PDs rated graduating fellows' skills as less than competent in advance care planning (38.5%), criticall illness communication (15.4%), and complex symptom management (15.4%). With a wide range of PC education practices and high rate of PD dissatisfaction with PC education in their programs, there is a need for standardized PC training recommendations and curriculum.