P3B032: Antidepressant Prescribing Practices of Pediatric Palliative Care Physicians

Background: There is growing evidence of co-occurrence of mental health diagnoses with complex medical illness in pediatric patients. Palliative care (PC) providers follow patients with serious illness longitudinally to address burdensome symptoms that affect quality of life and may be responsible for evaluation and treatment of mental health concerns. Education in managing psychologic distress for pediatric PC providers is limited. Addressing behavioral health concerns is emphasized by the American Academy of Pediatrics, yet most pediatricians do not feel comfortable with managing psychopharmacology. Few psychotropic medications are approved by the Food and Drug Administration for use in children and adolescents and most antidepressants are utilized off-label. Child psychiatrists are experts in psychopharmacology, yet access is limited. Given the rates of behavioral health issues in patients facing complex medical illness, PC providers are likely faced with managing psychopharmacology in pediatric palliative care patients.

Methods: An electronic survey approved by the American Academy of Hospice and Palliative Medicine (AAHPM )was distributed nationally to the following pediatric palliative care providers: physicians, advanced practice nurses, physician assistants and fellows to understand training and comfort in assessing for anxiety and depression and prescribing psychotropic medications.

Results: A total of 58 providers responded to the survey. The majority of respondents identified as attending level physicians working in a free-standing children’s hospital with inpatient and outpatient clinical duties. Nearly half (n=25) of the providers had greater than 10 years of experience in practice. Most respondents reported prescribing a variety of antidepressants including those off-label for anxiety and depression symptoms (n=45). Very few providers used formal assessment tools to screen for depression (n=7) or anxiety (n=4). Less than a third of providers consulted child psychiatry prior to prescribing antidepressants (n=13). More than half of providers (n=30) had no formal training in assessment and treatment of anxiety and depression in pediatric patients. Despite this, many providers (n=28) reported feeling somewhat to very comfortable in prescribing antidepressants while also endorsing interest in more training for behavioral health evaluation and treatment (n=47).

Conclusion: Limited training in assessing mental health concerns, prescribing and managing psychopharmacology suggests an opportunity for more targeted education for pediatric palliative care providers regarding antidepressant prescribing practices.