PM2023: Provider Perceptions of Neonatal Palliative Care in Southern US Compared to Their Northern US Counterparts

Background: Approximately 5.58/1000 infants die annually due life-threatening diagnoses. The South consistently has the highest infant mortality rate at 10/1000 live births (LB) compared to North with an average of 6/1000 LB. The prematurity rate in the South is 12-13% compared to 9% in the North. The provider perceptions and regional attitudes using validated surveys such as Neonatal Palliative Care Attitude Scale (NiPCAS) are necessary to provide valuable insights in regional differences in offering Palliative Care (PC) services.

Purpose: To determine if regional and demographic factors alter the neonatal provider (physician, fellow, nurse practitioner, and physician assistant) perceived barriers and facilitators in Level III/IV NICUs in the South verses Northeast.

Methods: This survey study was initiated at the University of Mississippi Medical Center and, after IRB approval, was sent to neonatal providers in Level III/IV NICU in the Southeast and Northeast regions of the United States. The demographic questions focused data on religious beliefs, political ideology, role of provider, training, years of practice and gender. The NiPCAS survey consists of 33 questions. Additional demographics questions were added bringing total to 38 and eight negatively worded questions were coded in reverse.

Results: There were 198 responses with a Response Rate of 49.75%. Three incomplete surveys were excluded and data was analyzed for 195 respondents. Demographic differences were significant in the areas of religiosity, political ideology, job role, and presence of an institutional PC service. (Table 1) The Southeast providers self-reported to be more religious and conservative in political ideology, while the Northeast providers had fewer formal PC services. It is unexpected that the Southeast had more formal PC services despite being more religious and conservative.
NiPCAS survey responses were presented in Chart 1. Among the NiPCAS survey questions and Likert scale responses, we noted a significant difference between regions in questions 16, 18, 23, 26, 27, 29, 31, and 37, all of which focused on areas of organizational and staff support for palliative care along with provider personal perceptions.

Conclusion: The data confirmed that Southeastern providers self-identify as more religious and conservative. Survey results showed the Southeastern providers have more exposure to death and provider distress was also higher despite having access to formal PC program. Data analysis is ongoing to investigate whether differences exist in one area of practice (organization, environment, provider factors) and to understand whether certain factors mitigate provider perceptions of PC.
Family involvement and education early in the clinical course for infants known to have life-limiting conditions could mitigate family resistance to palliative care. General education for prenatal providers and families of all NICU infants may breakdown barriers perceived by providers and to decrease tension or hesitancy when moving toward comfort care goals in unexpected end of life situations.