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Ms. Marston introduces her career beginnings as a response to the HIV/AIDS crisis in South Africa and describes some of the memorable experiences with youth she cared for. She explains her role in the initial implementation of pediatric palliative day care and home care as well as some of the challenges around growing provider, political, and community education in South Africa. Ms. Marston then talks about her international experiences meeting other in pioneers in the pediatric palliative care field. She touches on her work in developing hospice programs as well as some of the global challenges she’s experienced while establishing palliative care programs. Ms. Marston then goes on to itemize some of the challenges she’s faced in her career and successful methods to counteract those barriers. She concludes with her vison of child palliative care to be integrated into universal health coverage and “accessible to every child’s needs.”

Dr. Stephen Connor begins by describing some of his early professional experiences and mentors who supported him as he developed his interest in death and dying. Dr. Connor explains that after several “epiphany moments” and observing some of the death and dying practices abroad, he and several other like-minded professionals said: “You know, really, we should just start a hospice.” Dr. Connor then describes his early professional experiences of co-founding some of the earliest hospice programs in the United States, which drove his career from local hospice programming to national programming and finally into the international programming, research, publications, and evidence-based practices for the new fledgling field of children’s palliative care. Dr. Connor shares stories of pivotal moments from his career journey, which spans from the beginning of the pediatric palliative field, through the HIV/AIDS pandemic, all the way to the present. He explores multiple topics such as pain management, policy, program design as they relate to palliative care across the lifespan and from domestic to global socio-economic and techno-political differences. Dr. Connor explains the many ways children’s palliative care has changed since the field developed, as well as some of the barriers and successes he’s seen. Dr. Connor concludes with his goals for the future of pediatric palliative care to be accessible, policy protected, and serving the need for bereavement services.

Dr. Charles Corr begins by explaining how his career in pediatric death, dying, and bereavement began “almost accidently” as he stepped into the instructor role of a death and dying course in the mid-1970s. After that experience, Dr. Corr focused more on teaching classes on children and dying and gathering experiences alongside clinicians in the pediatric palliative field. He explains that as a trained academic writer, he was grateful when pediatric clinicians, patients, and families allowed him to share in their experiences and write them up. Dr. Corr goes on to describe the changes he’s experienced in the field that have removed some of the barriers he experienced in his early career, as well as the strengths of the multidimensional care he has experienced in the field. Dr. Corr ends by identifying patient transitions and seamless care models for patients, especially those that age out of pediatric care, as next frontier for this field.

Dr. Walco discusses his career beginnings in pediatric pain medicine. He describes field observations of “barbaric” practices that were founded on the notion that children did not experience pain the same way adults do. Dr. Walco recounts some landmark events in the 1980s and 1990s that gained public notoriety and aided in developing the field of pediatric pain medicine, including the Jeffrey Lawson case-study of a premature baby who was administered thoracic surgery while awake and conscious. Dr. Walco then describes early experiences in a field with general disregard for the pain and suffering ofpediatric patients. The need for pediatric health care advocacy drove him to connect with other health care providers to investigate multi-disciplinary, multi-organizational level solutions to improving the quality of life for pediatric patients. Dr. Walco describes the barriers and successes he has experienced in pain medicine as the sub-specialty has evolved in the last thirty-five years. Dr. Walco also describes the vision he seeks to achieve within pediatric pain medicine, as well as the work he is doing to continue to advance the field in establishing the best evidence-based practices.

Dr. Pamela Hinds begins by identifying some early experiences in her nursing career that led her towards a career in pediatric palliative care. She recalls some of the challenges of funding research and reframing some of the discipline’s stigma around child-death from “physician failure” to a patient and family-informed process of the bio-psycho-social changes that were happening to the child. Dr. Hinds goes on to describe some of the successes in pediatric palliative care being the cultivation of the multi-disciplinary then interdisciplinary team approach as well as the changes in the relationship between providers and families. Dr Hinds describes the on-going challenges in pediatric palliative care being credibility, funding, and policy, but she relays her excitement to continue to help develop this specialty into a vision of patient-first advocacy and patient choice.

As an intensivist, Dr. Levetown noted three things: 1. a large proportion of critically ill kids were actually “chronically dying.” 2. families’ information about their child’s condition was incomplete or inaccurate and, feeding unrealistic hopes and influencing decisions based on outcomes that “were really not on the table.” And 3. family units were often overwhelmed by the child’s illness, too often leaving the family unit in varying levels of social, physical, mental, and emotion ruin.

Dr. Levetown described her early experience with palliative care and hospice, her involvement with several research projects on reforming the culture of death at the academic level, the history of pediatric palliative care as a field and some of the early challenges implementing palliative care in a hospital setting. T he profound gratitude of patients’ families whom she accompanied through the end of life was an important counterbalance to the experience of being shunned by colleagues, who had dubbed her “Doctor Death.”

Dr. Levetown identifies several persistent barriers to pediatric palliative care, including funding, professional acceptance, availability/capacity of clinicians, and burdens on patient-family, such as time, effort, transportation, and funds. Dr. Levetown then explains with her vision of expanding both physical and financial accessibility of pediatric palliative services, community integration of palliative services, and revitalizing explorations into the biopsychosocial life stages of children and adolescents that have life-limiting conditions.