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Primary palliative care integrated model in paediatric ICU: an international cross-sectional study
Michelle Grunauer1, Caley Mikesell2, Gabriela Bustamante Callejas2
1Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador mgrunauer@usfq.edu.ec.
Insights
Globally, paediatric intensive care units (PICUs) partially implement integrated models of care (IMOC) combining critical care and palliative care. Implementation varies by country income, highlighting opportunities for improved pediatric palliative care (PPC) integration.
Area of Science:
- Pediatric critical care medicine
- Palliative care
- Global health
Background:
- Increasing numbers of technology-dependent children require specialized care in pediatric intensive care units (PICUs).
- An integrated model of care (IMOC), combining critical care and primary pediatric palliative care (PPC), may represent a standard of care for critically ill children.
- This study investigates the global implementation of IMOC in PICUs.
Purpose of the Study:
- To assess the worldwide implementation of integrated models of care (IMOC) in pediatric intensive care units (PICUs).
- To evaluate how PICUs integrate primary pediatric palliative care (PPC) within their critical care services.
- To identify factors influencing the adoption of IMOC across different global settings.
Main Methods:
- International multicentre cross-sectional observational study involving 34 PICUs across 18 countries.
- Data collected on the provision of primary PPC for all admitted children.
- Multilevel generalized linear models used to analyze differences in the Initiative for Paediatric Palliative Care (IPPC) curriculum scores.
Main Results:
- Units from high-income countries (HICs) demonstrated significantly higher IPPC scores in several domains compared to upper-middle-income countries (UMICs) and lower-income countries (LMICs/LICs).
- HICs had a statistically significant overall higher IPPC score than UMICs.
- Shorter shifts and multiple comorbidities were associated with higher IPPC scores, after adjusting for patient and center characteristics.
Conclusions:
- All surveyed PICUs provided some level of PPC and partially implemented IMOC.
- Significant disparities in IMOC implementation exist, correlating with country income levels.
- These findings underscore opportunities for improving PPC integration in critical care settings worldwide.
Objectives:
Numbers are rising of chronically and critically ill, technology-dependent children, who are admitted to paediatric intensive care units (PICUs). An integrated model of care (IMOC), that combines paediatric critical care and primary paediatric palliative care (PPC), in which either approach varies depending on the disease trajectory and is provided by the critical care team, might be a fundamental component of the best available standard of care for patients with life-threatening conditions. The objective of this study is to assess how PICUs around the world, implement an IMOC.
Methods:
International multicentre cross-sectional observational study. Data was gathered from 34 PICUs from 18 countries in the Americas, Europe, Asia and Africa. Provision of primary PPC was studied for each child admitted at the PICU. We evaluated score differences in each domain of the Initiative for Paediatric Palliative Care (IPPC) curriculum with multilevel generalised linear models.
Results:
High-income country (HIC) units made up 32.4% of the sample, upper-middle income countries (UMICs) 44.1%, lower-middle income/lower income countries (LMIC/LICs) 23.5%. HICs had four statistically significantly higher IPPC scores compared with UMICs (domains: 1 holistic care; 2 family support, 3B family involvement; 6B grief/bereavement healthcare provider support) and two compared with LMIC/LICs (domains: 6A grief/bereavement family support; 6B grief/bereavement healthcare provider support).HICs had a statistically significant overall higher IPPC score than UMICs. Adjusting for patient/centre characteristics, shorter shifts and multiple comorbidities were associated with higher IPPC scores.
Conclusions:
All centres offered some PPC provision and partially applied an IMOC. These results are encouraging, however, differences related to income and patients/unit evidence opportunities for improvement.
Trial Registration Number:
ISRCTN12556149.
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