Knowledge and attitudes of pediatric residents and pediatricians toward pediatric palliative and end‐of‐life care

Objective: Pediatric palliative care (PPC) is an emerging field in Turkey, with a rapidly increasing number of patients requiring such services. In order to provide appropriate support and treatment for this patient population and their families, physicians(especially pediatricians) must be adequately equipped in this field. This study aims to evaluate the knowledge levels and attitudes of pediatric residents and pediatricians working in two tertiary education and research hospital, which also hosts a pediatric palliative care unit, regarding PPC and end-of-life care, a critical component of palliative care. The ultimate goal is to identify gaps in physician preparedness and contribute to the development and implementation of effective PPC practices. Methods: This cross-sectional descriptive study was conducted via a structured questionnaire administered to 300 pediatric residents and pediatricians working at Ankara Bilkent City Hospital and Etlik City Hospital. The questionnaire consisted of 33 items assessing demographic data, knowledge, and attitudes related to palliative care, end-of-life care, and Do Not Resuscitate (DNR) decisions. Data were analyzed using the Chi-square test, with statistical significance set at p<0.05. Results: Knowledge levels were significantly associated with gender, prior training in palliative care, and clinical experience in relevant units. Female physicians had significantly higher correct response rates than male physicians (p=0.004). Participants who had received palliative care training or had worked in palliative care units demonstrated significantly greater knowledge (p<0.001). Knowledge of end-of-life care was notably correlated with clinical experience, whereas formal training alone did not have a statistically significant effect (p=0.486). Clinical experience in palliative care was the most influential factor in DNR decision-making (p=0.010). Among those opposed to DNR, the most common reason was the perception that it is "legally prohibited" (79%). Conclusion: Significant differences exist in pediatricians' knowledge levels regarding pediatric palliative and end-of-life care, influenced by gender, clinical experience, and educational background. However, for complex ethical issues such as end-of-life decisions and DNR, training alone appears insufficient; gaps in clinical practice and understanding of the legal framework remain evident. It is recommended that pediatric residency programs integrate comprehensive PPC modules covering ethical, communicative, and legal aspects. Keywords: Pediatric Palliative Care, End-of-Life Care, DNR, Pediatric Residency, Knowledge Level, Ethical Decision-Making, Medical Education