• Michael J McNeil, Erica C Kaye, Yuvanesh Vedaraju, Justin N Baker, Meenakshi Devidas, Julia Downing, Dylan Graetz, Radhikesh Ranadive, Abby R Rosenberg, Lori Wiener, and Meaghann S Weaver.
• St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, Tennesse, USA; St. Jude Children's Research Hospital, Division of Quality and Life and Palliative Care, Department of Oncology, Memphis, Tennesse, USA. Electronic address: michael.mcneil@stjude.org.
• J Pain Symptom Manage. 2021 Sep 1; 62 (3): e91e99e91-e99.

ContextThe coronavirus pandemic (COVID-19) has profoundly impacted the provision of pediatric palliative care (PPC) interventions including goals of care discussions, symptom management, and end-of-life care.ObjectiveGaining understanding of the professional and personal experiences of PPC providers on a global scale during COVID-19 is essential to improve clinical practices in an ongoing pandemic.MethodsThe Palliative Assessment of Needed DEvelopments & Modifications In the Era of Coronavirus Survey-Global survey was designed and distributed to assess changes in PPC practices resulting from COVID-19. Quantitative and qualitative data were captured through the survey.ResultsOne hundred and fifty-six providers were included in the final analysis with 59 countries and six continents represented (31% from lower- or lower middle-income countries). Nearly half of PPC providers (40%) reported programmatic economic insecurity or employment loss. Use of technology influenced communication processes for nearly all participants (91%), yet most PPC providers (72%) reported receiving no formal training in use of technological interfaces. Respondents described distress around challenges in provision of comfort at the end of life and witnessing patients' pain, fear, and isolation.ConclusionsPPC clinicians from around the world experienced challenges related to COVID-19. Technology was perceived as both helpful and a hinderance to high quality communication. The pandemic's financial impact translated into concerns about programmatic sustainability and job insecurity. Opportunities exist to apply these important experiential lessons learned to improve and sustain care for future patients, families, and interdisciplinary teams.Article SummaryThis original article describes the impact of the COVID-19 pandemic on pediatric palliative care clinicians from 59 countries including financial losses, use of virtual communication modalities, and the respondents' distress in provision of comfort at the end of life.Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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