Pediatric Cardiology

, Volume 38, Issue 7, pp 1324–1331 | Cite as

Pediatric Cardiology Provider Attitudes About Palliative Care: A Multicenter Survey Study

  • Emily Morell Balkin
  • James N. Kirkpatrick
  • Beth Kaufman
  • Keith M. Swetz
  • Lynn A. Sleeper
  • Joanne Wolfe
  • Elizabeth D. Blume
Original Article


While availability of palliative care consultation for children with advanced heart disease increases, little is known about cardiologist attitudes towards palliative care. We sought to describe perspectives of cardiologists regarding palliative care and to characterize their perceived competence in palliative care concepts. A cross-sectional survey of pediatric cardiologists and cardiac surgeons from 19 pediatric medical centers was performed. Overall response rate was 31% (183/589). Respondents had a median of 18 years of experience since medical school (range 2–49) and most practiced at academic centers (91%). Sixty-percent of respondents felt that palliative care consultations occur “too late” and the majority (85%) agreed that palliative care consultations are helpful. Barriers to requesting palliative care consultation were most frequently described as “referring to palliative care services too early will undermine parents’ hope” (45%) and “concern that parents will think I am giving up on their child” (56%). Only 33% of cardiologists reported feeling “very” or “moderately” competent in prognosticating life expectancy while over 60% felt competent caring for children with heart disease around end of life, and nearly 80% felt competent discussing goals of care and code status. Greater perceived competence was associated with subspecialty (heart failure/intensivist vs. other) (OR 3.6, 95% CI 1.6–8.1, p = 0.003) and didactic training (OR 6.27, 95% CI 1.8–21.8, p = 0.004). These results underscore the need for further training in palliative care skills for pediatric cardiologists. Enhancing palliative care skills among cardiologists and facilitating partnership with subspecialty palliative care teams may improve overall care of children with advanced heart disease.


Pediatric palliative care Pediatric end-of-life care Advanced heart disease Pediatric heart failure Physician perspectives 



This study was supported in part by the Advanced Cardiac Therapies Fund at Boston Children’s Heart Center. We thank the physicians who participated in this study for sharing their experiences and perspectives. Additionally, we thank Minmin Lu for her assistance with biostatistical analysis.

Compliance with Ethical Standards

Conflicts of interest

None of the authors have conflicts of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Emily Morell Balkin
    • 1
  • James N. Kirkpatrick
    • 2
  • Beth Kaufman
    • 3
  • Keith M. Swetz
    • 4
  • Lynn A. Sleeper
    • 5
  • Joanne Wolfe
    • 6
  • Elizabeth D. Blume
    • 5
  1. 1.Department of Pediatrics, UCSF Benioff Children’s HospitalUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Division of CardiologyUniversity of WashingtonSeattleUSA
  3. 3.Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of MedicineStanford UniversityPalo AltoUSA
  4. 4.Division of Gerontology, Geriatrics and Palliative CareUniversity of Alabama–BirminghamBirminghamUSA
  5. 5.Department of CardiologyBoston Children’s HospitalBostonUSA
  6. 6.Department of Psychosocial Oncology and Palliative CareDana-Farber Cancer InstituteBostonUSA

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