Factors associated with perceived barriers to pediatric palliative care: a survey of pediatricians in Florida and California

Purpose: The provision and uptake of pediatric palliative care continues to be plagued by barriers. Several studies have documented these barriers, but none have done so with a diverse sample (most are at a single institution) or specifically about pediatric palliative care. Moreover, none have investigated the factors associated with perceived barriers. Our study has two aims: (1) to describe the barriers to pediatric palliative care as reported by a group of pediatricians practicing in two large States in the US; and (2) to identify factors associated with these perceived barriers. Methods: Cross-sectional survey data were collected from 303 pediatricians in Florida and California. Results: The two greatest barriers reported by the pediatricians were related to families' reluctance to accept palliative care (95%) and families viewing palliative care as giving up (94%). Only 42% of pediatricians noted that reimbursement was a barrier. Across all the regressions, three factors were consistently associated with barriers to palliative care: race/ethnicity of pediatrician practice setting, and the percentage of low-income patients. Conclusions: Our findings can be used to develop targeted educational interventions towards providers and families. Understanding the factors that are driving the low uptake in palliative care is the first step in advancing pediatric palliative care overall.