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Integrating palliative care into the PICU: a report from the Improving Palliative Care in the ICU Advisory Board
Renee Boss1, Judith Nelson, David Weissman
11Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. 2Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. 3Center to Advance Palliative Care, Icahn School of Medicine at Mount Sinai, New York, NY. 4Center for Health Research, College of Nursing, Wayne State University, Detroit, MI. 5Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA. 6Cerebrovascular Center, Cleveland Clinic, Cleveland, OH. 7VA Palo Alto Health Care System, Palo Alto, CA. 8Section of Palliative Care, North Shore-Long Island Jewish Health System, Manhasset NY. 9Department of Surgery, New Jersey Medical School-University of Medicine and Dentistry of New Jersey, Newark, NJ. 10Hartford Hospital, Hartford, CT. 11Department of Physiological Nursing, University of California, San Francisco, CA. 12Lehigh Valley Health Network, Allentown, PA. 13Boise, Meridian, & Mountain States Tumor Institute, St. Luke's Hospital, Boise, ID. 14Departments of Surgery and Health Policy, Medical College of Wisconsin, Milwaukee WI 15Departments of Rehabilitation Medicine, Pediatrics and Bioethics & Humanities, University of Washington School of Medicine, Seattle, WA.
Objective:
This review highlights benefits that patients, families and clinicians can expect to realize when palliative care is intentionally incorporated into the PICU.
Data Sources:
We searched the MEDLINE database from inception to January 2014 for English-language articles using the terms "palliative care" or "end of life care" or "supportive care" and "pediatric intensive care." We also hand-searched reference lists and author files and relevant tools on the Center to Advance Palliative Care website.
Study Selection:
Two authors (physicians with experience in pediatric intensive care and palliative care) made final selections.
Data Extraction:
We critically reviewed the existing data and tools to identify strategies for incorporating palliative care into the PICU.
Data Synthesis:
The Improving Palliative Care in the ICU Advisory Board used data and experience to address key questions relating to: pain and symptom management, enhancing quality of life, communication and decision-making, length of stay, sites of care, and grief and bereavement.
Conclusions:
Palliative care should begin at the time of a potentially life-limiting diagnosis and continue throughout the disease trajectory, regardless of the expected outcome. Although the PICU is often used for short term postoperative stabilization, PICU clinicians also care for many chronically ill children with complex underlying conditions and others receiving intensive care for prolonged periods. Integrating palliative care delivery into the PICU is rapidly becoming the standard for high quality care of critically ill children. Interdisciplinary ICU staff can take advantage of the growing resources for continuing education in pediatric palliative care principles and interventions.
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