Advanced Pain & Palliative Care Workshop

EPEC - Pediatrics

Education in Palliative and End-of-life Care

Rome - October 24-27, 2023



The Maruzza Foundation endeavours to enhance access to quality child-specific palliative care through the organisation of cutting-edge training opportunities developed for healthcare professionals working in a series of contexts and diverse care settings with children with serious illness and their families.

EPEC-Pediatrics curriculum features state-of-the-art knowledge in pain treatment, symptom management and training in the skills required to address key domains in Pediatric Palliative Care. The program is designed to give pediatric healthcare professionals (incl. physicians, nurse practitioners, nurses, social workers, psychologists etc.) the knowledge and skills needed to provide excellent palliative care to their patients and their families.

20 Modules

M1. What is Pediatric Palliative Care and Why Does it Matter: Palliative Care Overview

  • Define PPC as a set of tasks
  • Identify predictable opportunities for palliative care intervention at different stages of disease
  • Describe when and how to utilize a subspecialty palliative care team
  • Evaluate myths and assumptions about PPC

M3: Family Centered Care

  • Define Family-Centered Care (FCC)
  • Learn the four key principles in FCC
  • Describe strategies for delivering effective FCC in pediatric palliative care
  • Understand and reduce barriers to the delivery of FCC

M4: Grief and Bereavement

  • Review theories of grief
  • Assess grief in children
  • Use developmentally based strategies to address grief
  • Discuss grief related to the loss of a child and strategies to address family grief

M5: Self Care for Professionals

  • Understand how self-care is a core competency in palliative and end of life care
  • Recognize what triggers stress and burnout
  • Develop a self-care plan that reduces stress and fosters personal growth and well-being

M6: Team Collaboration and Effectiveness

  • Identify the conceptual basis for teamwork in palliative care
  • Describe different types of teams in palliative care
  • Name specific advantages and challenges of teamwork

M7: Communication & Planning

  • Describe the 6 steps of the SPIKES model for giving bad news
  • Detail reasons for communicating prognosis
  • Learn methods for communicating prognosis
  • Understand ways to elicit goals of care and to discuss advanced care planning

M10: Multi-Modal Analgesia

  • Review assumptions about opioid use in children
  • Evaluate the 4 WHO-Principles of acute pediatric pain management
  • Discuss the concept of Multimodal Analgesia
  • Calculate morphine requirements for a child in severe pain

M11: Opioid Selection and Opioid Rotation

  • Review opioids commonly used in pediatric palliative care
  • Pharmacology
  • Routes of administration
  • Common adverse effects
  • Review opioids not recommended for pediatric use
  • Practice opioid rotation in a case example

M12: Management of Neuropathic Pain Management and Adjuvant Analgesia

  • Appreciate the high prevalence of neuropathic pain in pediatric palliative care
  • Define neuropathic pain and describe main causes in pediatric patients
  • Emphasize the role of opioids as a first-line agent in neuropathic pain management
  • Develop a step-by-step treatment approach for neuropathic pain, including pharmacologic (opioids, non-opioids, adjuvants), procedural and integrative medicine approaches

M13: Procedural Pain Management Strategies

  • Describe the evidence for the importance of managing procedural pain
  • Review the 4 essential pain management strategies for needle procedures
  • Identify pharmacologic agents including dose, route of administration, monitoring, and adverse effects
  • Identify behavioral and integrative strategies that facilitate coping with procedures

M14: Chronic Complex Pain

  • Discuss the prevalence of chronic pain and underlying pathophysiology in children
  • Appreciate that different chronic pain syndromes are often considered manifestations of an underlying vulnerability rather than separate disorder
  • Review the limited role for pharmacotherapy in children with chronic pain
  • Opioids are usually not indicated!
  • Stress the importance of a rehabilitative, interdisciplinary team approach in managing chronic pain
  • Discuss management of children who have both acute pain, such as vaso-occlusive crisis in sickle-cell disease, and chronic daily musculoskeletal pain

M15: Management of Gastrointestinal Symptoms

  • State the spectrum and impact of gastrointestinal symptoms
  • Recognize pathophysiology involved in nausea and vomiting, and learn to prescribe appropriate antiemetic therapy
  • Diagnose and treat diarrhea and constipation
  • Explain the diagnosis and treatment of anorexia-cachexia syndrome
  • Discuss weight changes and loss of appetite with caregivers

M16: Management of Respiratory Symptoms

  • Appreciate the high prevalence of dyspnea, excess respiratory secretions and cough in pediatric palliative care and often inadequate treatment by clinicians
  • Discuss pathophysiology of common respiratory symptom in pediatric palliative care
  • Describe the role of opioids as a first-line agent in dyspnea
  • Develop a step-by-step approach in managing dyspnea and other respiratory symptoms

M17: Management of Emotional and Behavioral Symptoms

  • Describe approaches to emotional and behavioral aspects of palliative care
  • Discuss “phenotypes” of psychological and behavioral pathology in seriously ill children
  • Review the assessment and potential treatments for each phenotype
  • Identify thresholds for referral to mental health clinicians

M18: Management of Neurological Symptoms

  • Review neurological complications of children with serious illnesses, including advanced pediatric hematology/oncology conditions, and treatment strategies
  • Identify causes of pain behaviors in children with neurological impairment
  • Develop step-by-step approach to manage distressing neurological symptoms in pediatric palliative care

M19: Management of Refractory Distress

  • Describe persistent myths about palliative sedation
  • Explain the circumstances under which palliative sedation may be indicated
  • Describe recommended dosing for palliative sedation in children
  • Review the potential alternatives to palliative sedation

M20: Preparation for Imminent Death

  • Define the end-of-life period
  • Describe the tasks necessary for managing pain and distress at end of life
  • Identify important issues that require careful communication and planning
  • Describe the essential components of good care at the very end of life

M21: Integrative Medicine

  • Describe how integrative medicine strategies can enhance care for children with life-threatening conditions.
  • Practice a relaxation and mental imagery (RMI) exercise.
  • Review importance of safe and effective integrative medicine modalities to improve pain and symptom management as well as quality of life for seriously ill children

M24: Methadone

  • Review advantages and disadvantages of methadone use
  • Evaluate potential adverse effects of methadone
  • Explain difference of half-life compared to other opioids
  • Practice opioid rotation to methadone

Extra lecture

  • Addressing Hope at Times of Clinical Uncertainty: The Goals of care discussion as a fundamental PPC intervention

Key Teaching Modalities

  • Interactive Lecture
  • Role Play
  • Case Study