{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T17:16:56Z","timestamp":1787851016752,"version":"build-2784847793"},"reference-count":38,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate neonatal providers\u2019 comfort with end-of-life care (EOLC) and perceived palliative care (PC) resources using a two-domain analytic framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Two-site, mixed-methods survey of nurses, neonatologists, pediatric hospitalists, advanced practice providers, and trainees in a Level III and Level IV NICU. Items were grouped into two domains: (1) comfort with participation in EOLC and (2) perceived PC resources and support. Multivariable hierarchical linear regression identified independent predictors of each domain, and free-text responses underwent inductive thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighty-three clinicians responded. EOLC experience (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) and prior EOLC training (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.037) predicted higher comfort, whereas trainee status predicted lower comfort (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.012) (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.353). For perceived PC resources, provider role and NICU site were associated with higher scores (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.130). Qualitative themes highlighted competency gaps, personal and interpersonal conflicts, variable team culture, and structural constraints.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Provider comfort in neonatal EOLC reflects experiential, educational, and system-level factors. Interventions must combine training with cultural and structural investment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10499091261483161","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T12:48:54Z","timestamp":1787662134000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comfort and Conflict in Neonatal End-of-Life Care: A Mixed-Methods Study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7709-7494","authenticated-orcid":false,"given":"Danielle","family":"Zamalin","sequence":"first","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai Hospital"},{"name":"Children\u2019s National Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Reed","sequence":"additional","affiliation":[{"name":"Division of Newborn Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0588-3722","authenticated-orcid":false,"given":"Robert","family":"Green","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8562-8929","authenticated-orcid":false,"given":"Matthew J","family":"Drago","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"issue":"3","key":"e_1_3_5_2_2","first-page":"S215","article-title":"Epidemiology, economics, and ethics in the NICU: reflections from 30 years of neonatology practice","volume":"45","author":"Meadow W","year":"2007","unstructured":"Meadow W. 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