Exposure to paediatric end-of-life care: the experiences and coping strategies of paediatric registrars in South Africa
Date
2023-05
Authors
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Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH ABSTRACT: Introduction: The death of a paediatric patient is challenging but inevitable for paediatric doctors in South Africa. This study aimed to document how paediatric registrars in South Africa experience end-of-life care and death, which coping strategies they utilise and what the barriers to and facilitators are for coping with paediatric deaths in the South African context. Method: This was a cross sectional electronic survey of university registered paediatric registrars in South Africa. A total of 326 paediatric registrars were contacted from eight out of nine universities with medical schools that offer paediatric postgraduate training from March to June 2021. Results: Paediatric registrars in South Africa had high exposure to paediatric deaths with a reported mean of 14 paediatric deaths in a year. More than a third (37/98) of paediatric registrars did not feel prepared to cope with the death of a child, and more than 40% (39/96) had considered leaving the specialty due to difficulties with coping with paediatric death. This study showed no significant difference in perceived ability to cope with a death when comparing registrar demographics, experience, or prior training. Overall, coping strategies were largely adaptive. Emotion-focused and problem focused coping styles were used equally. Individual sub facets for coping styles were scored. Acceptance (emotion-focused) scored highest, followed by religion (emotion-focused) and self-distraction (avoidant). Overtly maladaptive coping strategies scored low. The mode of death and circumstances surrounding death might impact on the registrar’s ability to cope and should be considered. Debriefing was only superficially assessed but appeared to be used inconsistently to support staff following paediatric deaths. Most participants indicated that holistic paediatric end-of life care training would be valuable. Conclusion: South African paediatric registrars experience considerably more deaths than high income country counterparts, in more challenging socioeconomic conditions. Paediatric training facilities should provide registrars with formal end-of-life care training and ensure adequate support when paediatric registrars are involved in paediatric deaths to protect their mental wellbeing and improve end-of-life care for paediatric patients and their families.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
Description
Thesis (MMed)--Stellenbosch University, 2023.