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"Who Has the Relationship?": Caring for a Shared Population of Children with Medical Complexity
P Galen DiDomizio1, Madeleine Johnson2, Annie Friedrich3
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Insights
Pediatric complex care and palliative care teams share distinct and overlapping roles for children with medical complexity (CMC). Provider relationships, not program boundaries, often define these roles, highlighting a need for further collaboration studies.
Area of Science:
- Pediatric Healthcare
- Interdisciplinary Care Models
- Complex Care Management
Background:
- Academic pediatric centers utilize complex care and palliative care programs for children with medical complexity (CMC).
- Limited data exists on optimal collaboration strategies between these specialized pediatric care teams.
- Understanding the distinct and overlapping roles is crucial for improving care coordination for CMC.
Purpose of the Study:
- To explore the roles and responsibilities of pediatric complex care and palliative care providers.
- To identify distinct and overlapping functions in managing shared CMC populations.
- To understand provider perspectives on inter-team collaboration for CMC.
Main Methods:
- Qualitative study employing semi-structured interviews with pediatric providers.
- Participants included physicians and nurse practitioners in complex care and palliative care.
- Thematic analysis was used to analyze transcribed interview data from Midwestern academic medical centers.
Main Results:
- Complex care and palliative care teams function on a spectrum of roles: complex-leaning, palliative-leaning, or blended.
- Provider-family relationships, rather than strict program boundaries, often shape clinical roles.
- Significant overlap exists in the responsibilities of both teams when caring for CMC.
Conclusions:
- Pediatric complex care and palliative care teams offer both unique and shared services for CMC.
- The extent of role overlap varies by institution and individual provider-family dynamics.
- Further research is recommended to investigate collaborative practices and family perspectives on dual-team care.
Abstract:
Many academic pediatric centers care for children with medical complexity (CMC) through established complex care and palliative care programs. There are little prior data investigating best practices for collaboration between these two subspecialties in caring for CMC. The aim of this study is to explore the distinct and overlapping roles and responsibilities of pediatric complex care and palliative care teams as identified by providers when caring for a shared population of CMC and their families. Qualitative analysis of semi-structured interviews. Pediatric complex care and palliative care providers (physicians and nurse practitioners) actively caring for CMC at academic medical centers in the Midwestern United States. Data obtained from semi-structured interviews were audio-recorded, transcribed, coded, and analyzed by two independent reviewers using thematic analysis. Interviews revealed that both programs operate within a spectrum of clinical roles, thematically organized as complex-leaning, palliative-leaning, or blended. Responses highlighted that clinical roles are more likely defined by relationships established between specific providers and families, instead of by clear boundaries between the two programs. Pediatric complex care and palliative care teams provide both distinct and overlapping roles in caring for CMC. This overlap can vary between institutions and individual provider-caregiver dyads. Further studies are needed to explore collaborative practices on shared patients and caregiver perceptions on the benefits and challenges of utilizing both teams concurrently. This qualitative study of providers of CMC highlights the overlapping roles and responsibilities between complex care and palliative care teams in caring for a shared population of patients and families.
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