Implementing the PAR Scale in a Pediatric Concurrent Care Setting: A Quality Improvement Project

Area of Science:

• Pediatric Palliative Care
• Quality Improvement
• Healthcare Communication

Background:

• Fragmented communication regarding family goals of care is common for pediatric patients in concurrent hospice and palliative care during hospitalizations.
• Ensuring treatment aligns with family preferences is vital in complex pediatric settings.

Purpose of the Study:

• To evaluate clinician and care coordinator experiences with implementing the Preference for Acute Rehospitalization Scale.
• To assess the impact of a new communication tool on awareness of family goals and decision-making confidence.

Main Methods:

• A quality improvement project utilized a pre- and postimplementation survey design.
• Surveys assessed interdisciplinary team members' awareness of family goals, decision-making confidence, and perceptions of the tool.
• Participants included clinicians and care coordinators at Children's Nebraska.

Main Results:

• Clinicians showed general openness to standardized communication tools.
• No statistically significant differences were found in survey items assessing awareness, confidence, or perceptions postimplementation.
• The study highlighted challenges in tool adoption within complex pediatric care.

Conclusions:

• Successful adoption of communication tools in pediatric hospice and palliative care requires more than initial implementation.
• Sustained education, seamless workflow integration, and robust interdisciplinary engagement are necessary.
• These factors are critical for ensuring treatment remains aligned with family preferences.