Impact of Palliative Care Educational Program on Knowledge and Attitude Regarding Pediatric Palliative Care Among Healthcare Professionals Working in Nepal.

There is a critical and persistent unmet need for pediatric palliative care (PPC) services in low- and middle-income countries (LMICs), with the lack of specialized training among healthcare professionals (HCPs) identified as a major barrier. This study aimed to evaluate the impact of a structured educational intervention on the knowledge and attitudes of HCPs in Nepal toward PPC. We utilized the Project ECHO (Extension for Community Healthcare Outcomes) model, an interactive, technology-enabled, flipped-classroom approach designed to build capacity in resource-limited settings. The program consisted of nine weekly 75-min online sessions, incorporating expert-led didactic lectures, breakout room discussions, and case-based learning. Using a culturally and contextually adapted, validated questionnaire, we measured the changes in Likert scores before and after the educational intervention to assess changes in participants' PPC-related knowledge and attitudes. Of the 55 HCPs who enrolled in the training, 40 completed both the course and the questionnaire. Among them, 19 (47.5%) were nurses, 17 (42.5%) physicians, 2 (5.0%) psychosocial counselors, and 1 (2.5%) a family support officer. Statistically significant improvements were observed in both knowledge and attitudes regarding PPC. All 40 participants (100.0%) reported that the training was valuable and would recommend it to peers. The most cited barriers to participation included time constraints (72.5%), and internet connectivity issues (40.0%). These findings suggest that virtual PPC education delivered through the Project ECHO model is a promising and effective strategy to enhance knowledge, attitudes, and confidence among HCPs in resource-constrained settings. This study supports its potential to address the PPC education gap in LMICs like Nepal. Furthermore, the validated questionnaire developed through this initiative may serve as a useful tool for evaluating similar training initiatives.