The Preference for Acute Rehospitalization Scale: Evaluating Preference for Acute Rehospitalization in Pediatric...

Area of Science:

• Pediatric Palliative Care
• Hospice and Palliative Medicine
• Healthcare Administration

Background:

• The Affordable Care Act enables pediatric concurrent care hospice, allowing children to receive life-prolonging treatments alongside hospice services.
• This concurrent care model can lead to confusion regarding evolving goals of care (GOC) among hospice staff, palliative care teams, and families.
• Clear communication of GOC is crucial for aligning care with patient and family preferences.

Purpose of the Study:

• To develop and evaluate the Preference for Acute Rehospitalization (PAR) Scale as a tool to clarify GOC for children in concurrent care hospice.
• To assess the usability and impact of the PAR Scale on hospice and palliative care providers' understanding of family GOC and confidence in decision-making.

Main Methods:

• A five-point PAR Scale was created by hospice and palliative care teams for children receiving concurrent care.
• The scale was implemented, and after 3 months, users (hospice and palliative care staff) were surveyed about their experience with the PAR Scale.

Main Results:

• A majority of users agreed or strongly agreed that the PAR Scale enhanced their understanding of families' GOC.
• Most users reported increased confidence in providing advice, particularly for urgent care questions, after using the PAR Scale.
• The PAR Scale was perceived as a valuable tool for quickly identifying GOC in this population.

Conclusions:

• The PAR Scale is an effective tool for hospice and palliative care providers to ascertain GOC for families utilizing the concurrent care for children hospice benefit.
• Further research with a larger cohort is recommended to validate these findings and confirm the PAR Scale's utility.
• The PAR Scale facilitates better communication and alignment of care with family wishes in complex pediatric end-of-life scenarios.