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Dr. Ferrell begins with her personal introduction to the need for palliative care and hospice from her experience working as a nurse in adult oncology. She describes how she stood alone in her quest to delivery better quality end of life care and decided to pursue her PhD in order to supply the data needed for this emerging field. After years of research and practice Dr. Ferrell joined forces with other hospice and palliative care leaders to expand the field or research and practice to pediatric medicine. She explains how she was drawn to pediatric palliative care and the need for specialization within the field of research. She explains the advancements that have taken part in pediatric palliative care over the past ten years as the specialization has gained greater attention. Dr. Ferrell then goes on to describe some of the changes and challenges presented to pediatric palliative care, citing health policy to be one of the greatest barriers. Finally, Dr. Ferrell describes her greatest successes and her aspiration for all clinicians receive training on palliative care before entering into practice.

Dr. Stefan Friedrichsdorf begins the interview by describing his time as medical trainee in Germany and his observations that the medical treatments physicians were giving seriously ill children were often the cause of the distressing pain symptoms children experienced. In his pursuit to find out more about managing pain in children, he found there were no existing resources -- no books, no courses, no practices around him. In a chance opportunity, one of his peers was awarded funding to conduct an assessment of pediatric palliative care in Germany, and so Dr. Friedrichsdorf became the manager of that study and began his lifelong mission to eliminate medically caused pain and suffering in children.

Dr. Friedrichsdorf then describes participating in an opportunity sponsored by the Open Society led by George Soros after the fall of East Germany, to participate in several international conferences with other people interested studying pediatric palliative care. This included other like-minded individuals from the United Kingdom, Australia, Albania, the United States, and Canada. Dr. Friedrichsdorf comments on the three different types of healthcare models in the world, how current services and realities were derived from the circumstances created by these healthcare models, and several shocking and egregious situations and practices that he experienced and found to be detrimental to the health of the patient children and their families.

From the friendships he made during the beginning sessions of international pediatric palliative care conferences, Dr. Friedrichsdorf created a successful training collaborative and developed The Educational Palliative and End of life Care (EPEC) pediatrics training modules and certification resource for practitioners. With this training tool, he expects to continue to see the current and next generations of practitioners be well trained in alleviating pain and distressing symptoms in children.

Dr. Friedrichsdorf concludes the interview by listing his plans to continue to build a future where all practitioners are trained in at least primary palliative care, increase the global access to pediatric palliative and pain care free of economic restrictions, implement a reframing of physician training to stop blindly pushing impractical intensive treatments when a palliative treatment would be more effective at reducing suffering and burden on children, and for the establishment of sustainable interdisciplinary palliative care teams in every children’s hospital.

Dr. Kanwaljeet Anand begins the interview by describing his journey into pediatric pain and symptom management through his work examining metabolic and hormonal stress responses of infants undergoing surgery. From this work, he retraced history to understand where the notion of ‘babies don’t feel pain’ came from, and then eventually studied more closely the pain responses of infants.

Dr. Anand describes how he was surprised to find that babies mounted three times the metabolic stress response to surgery as compared to adults, and how his pediatric pain research initially received a lukewarm response from his peers. However, that lukewarm response turned into a massive media scandal as news outlets sensationalized Dr. Anand’s work as ‘disgraceful doctors performing surgery on babies without anesthesia.’ Eventually this media frenzy ended with public apologies printed in the same newspapers.

Since that media incident early in his career, Dr. Anand describes his journey as being “doubly blessed” by immense support from many colleagues and peers as he doubled down into some field-defining research on pain in neonates and infants, as well as clinical work for underserved populations in the “Deep South” of the United States.

Dr. Balfour Mount begins the interview by describing a pivotal moment when he heard Dr. Elisabeth Kübler-Ross lecture at McGill University’s Royal Victoria Hospital. Dr. Mount had not previously heard of Kübler-Ross’s work and was impressed to learn about the unmet needs of the dying. When Dr. Mount conducted a similar study at the RVH, he found the same deficiencies in care and carried out a two year pilot project aimed at addressing these needs through the creation of an in-patient ward, a consultation service, a home care program, an outpatient clinic, and a bereavement follow-up service.

Dr. Dangel begins the interview describing his experiences as a pediatric anesthesiologist witnessing children dying while receiving unnecessary aggressive treatment during the end-of-life. He also describes several pivotal experiences learning about and seeing other countries develop pediatric hospices. When he brought back his experiences to his home institution, he was not well received and consequently left to seek an environment to nurture his vision for pediatric palliative and hospice care.

Dr. Dangel comments that this was not his first time bringing new ideas into Polish medicine since he “introduced the modern techniques of regional anesthesia and analgesia in children,” in the 1980s. He then mentions that he was more than comfortable making the “conscious choice” to have his own “splendid isolation from the inhumane hospital medicine.”

He then describes the barriers he faced and overcame, such as lack of funding, training gaps for clinicians, no transportation for his staff, failing personal health, a research block from the ethnical committees in Poland, and “single case of malpractice at the medical court for using the ketogenic diet, which I designed for my hospice patient”.

Dr. Dangel goes on to describe his work in leading Polish medicine to establishing pediatric palliative and hospice care through his work in policy, peer-reviewed studies, publications, and books, public outreach, and coaching of other professionals. He also describes some of his biggest challenges today being lack of cooperation from the Polish government, lack of official accreditation, and government blocks on some palliative practices.

He then also describes the strengths of the current Polish practices of pediatric palliative and hospice to be the establishment of the Warsaw Hospice for Children Foundation who provide supportive services and organizational outreach as well as Polish societal values.

Finally, Dr. Dangel describes his vision for the future of pediatric and hospice care to be recognized as a branch of medicine in Poland, increase clinician knowledge and competency of palliative practices, increase the awareness and palliative training of other disciplines, such as gynecologists and obstetricians, establish a national research center, establish a journal of pediatric and perinatal palliative care, and to increase pediatric palliative and hospice consults with experts and ethics committees.