Development and Execution of the First Pediatric Palliative Fellowship in Latin America

{"title":"Development and Execution of the First Pediatric Palliative Fellowship in Latin America","authors":"Silvia Rivas MD MS,&nbsp;Jaime Guarda First International Pediatric Palliative Care Fellow Guatemala (UNOP Universidad Francisco Marroquin)/USA(St Jude University of Utah),&nbsp;Ximena García-Quintero MD MSc,&nbsp;Leeanna Fox-Irwin MAED,&nbsp;Shirley Montufar BS,&nbsp;Federico Antillón MD PhD,&nbsp;Daniel Moreira MD MEd,&nbsp;Claudia Delgado-Corcoran MD MPH,&nbsp;Courtney Perkins MHA,&nbsp;Julia Evans MOT MBA,&nbsp;Michael McNeil MD MPH,&nbsp;Kathryn Gradick MD MHS","doi":"10.1016/j.jpainsymman.2025.02.049","DOIUrl":null,"url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Evaluate implications of limited access to pediatric palliative care in low- and middle-income countries.</div><div>2. Apply lessons learned from a novel trilateral partnership to the design and execution of similar global capacity-building training opportunities in other settings.</div></div><div><h3>Key Message</h3><div>Access to specialized training in pediatric palliative care (PPC) is needed in low- and middle-income countries. Leveraging resources from a trilateral international partnership led to the development of a successful, novel PPC fellowship in Latin America.</div></div><div><h3>Abstract</h3><div>Nearly two-thirds of countries lack access to pediatric palliative care (PPC) (1), even though children in low- and middle-income countries experience higher illness-related morbidity and mortality (2). Access to specialized training in PPC is poor in these countries (3), despite accounting for 98% of the global need for PPC (4). No PPC fellowships exist in Latin America, and in one survey nearly all Latin American physicians requested additional training in PPC (5).</div></div><div><h3>Objectives</h3><div>Describe the development and execution of the first ever American Committee on Graduate Medical Education-International (ACGME-I) PPC fellowship in Latin America.</div></div><div><h3>Methods</h3><div>We leveraged resources from a trilateral partnership between Unidad Nacional de Oncología Pediátrica in Guatemala City, Guatemala, St. Jude's Children's Research Hospital in Memphis, Tennessee, and University of Utah in Salt Lake City, Utah, to create a one-year PPC fellowship with rotations at all three sites. Benefits of the multi-site approach included exposure to a spectrum of diagnoses within PPC, including oncologic, cardiac, neurologic, and genetic conditions, across prenatal, outpatient, and inpatient settings, and at various points in the course of illness, including advanced disease presentation in Guatemala. We developed a curriculum based on ACGME-I competencies, including patient care, communication, and research. Recruitment consisted of advertising through Latin American list-servs, global training opportunities, and international conferences.</div></div><div><h3>Results</h3><div>Thirteen applicants were interviewed virtually by representatives from all three sites, with one applicant selected from Hospital Luis Calvo Mackenna (HLCM) in Chile. Our first fellow successfully completed the fellowship from June 2023-June 2024, and has since submitted an original manuscript, broadened access to PPC and expanded symptom management expertise at HLCM. Recruitment for the coming year is ongoing, with plans to ultimately support two fellows annually.</div></div><div><h3>Conclusion</h3><div>Leveraging resources from a trilateral international partnership facilitates the development of a novel PPC fellowship and supports global capacity-building.</div></div><div><h3>References</h3><div>1. Knapp C, Woodworth L, Wright M, Downing J, Drake R, Fowler-Kerry S, et al. Pediatric palliative care provision around the world: a systematic review. Pediatr Blood Cancer. 2011;57(3):361-8. <span><span>https://doi.org/10.1002/pbc.23100</span><svg><path></path></svg></span> 2. Lam CG, Howard SC, Bouffet E, Pritchard-Jones K. Science and health for all children with cancer. Science. 2019;363(6432):1182-6. <span><span>https://doi.org/10.1126/science.aaw4892</span><svg><path></path></svg></span> 3. Zuniga-Villanueva G, Ramos-Guerrero JA, Osio-Saldaña M, Casas JA, Marston J, Okhuysen-Cawley R. Quality indicators in pediatric palliative care: considerations for Latin America. Children (Basel). 2021;8(3):250. <span><span>https://doi.org/10.3390/children8030250</span><svg><path></path></svg></span> 4. Downing J, Powell RA, Marston J, Huwa C, Chandra L, Garchakova A, Harding R. Children's palliative care in low- and middle-income countries. Arch Dis Child. 2016;101(1):85-90. <span><span>https://doi.org/10.1136/archdischild-2015-308307</span><svg><path></path></svg></span> 5. McNeil MJ, Ehrlich BS, Wang H, Vedaraju Y, Bustamante M, Dussel V, et al. Physician perceptions of palliative care for children with cancer in Latin America. JAMA Netw Open. 2022;5(3):e221245. doi:10.1001/jamanetworkopen.2022.1245</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e438-e439"},"PeriodicalIF":3.2000,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pain and symptom management","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0885392425001095","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}