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When and Why Do Neonatal and Pediatric Critical Care Physicians Consult Palliative Care?

Claire A Richards1,2, Helene Starks1,3, M Rebecca O'Connor4

  • 11 Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.

The American Journal of Hospice & Palliative Care
|November 29, 2017
PubMed

Insights

Pediatric critical care physicians see palliative care as key for families facing communication challenges due to complex conditions. Integrating palliative care improves outcomes but faces organizational barriers.

Area of Science:

  • Pediatric Critical Care Medicine
  • Palliative Care
  • Healthcare Communication

Background:

  • Parents of children in neonatal and pediatric intensive care units (ICUs) face high risks of psychological distress.
  • Palliative care integration may enhance outcomes for critically ill children and their families.
  • Clear indicators for involving palliative care specialists in pediatric ICUs are lacking.

Purpose of the Study:

  • To explore perspectives of neonatal and pediatric critical care physicians on indicators for palliative care consultation.
  • To understand the rationale behind involving palliative care consultants in critical care settings.

Main Methods:

  • Conducted semistructured interviews with 22 attending physicians in neonatal, pediatric, and cardiothoracic ICUs.
  • Utilized content and thematic analyses to interpret transcribed interview data.

Main Results:

  • Identified two main themes for palliative care involvement: palliative care expertise (support, communication bridging) and organizational factors (competing priorities, care fragmentation).
  • Palliative care was most effective for families with communication issues stemming from organizational factors like long stays and medical complexity.
  • Organizational factors sometimes hindered palliative care consultants' ability to bridge communication.

Conclusions:

  • Palliative care consultants are valued when they enhance efficiency and harmony in pediatric ICUs.
  • Physicians recommend strengthening primary palliative care capacity within ICU teams.
  • System-level changes and critical care physician training on chronic illness and disability are suggested.
Abstract

Keywords:
care coordinationcomplex chronic conditionscritical carefamilyhealth-care qualitypalliative carepediatric intensive care unit

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