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

Title

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

Creator

Richards CA;Starks H;O'Connor MR;Bourget E;Lindhorst T;Hays R;Doorenbos AZ

Publisher

American Journal of Hospice and Palliative Care

Date

2018

Subject

Care coordination;Communication;complex chronic conditions;critical care;Critical Care/organization & administration;family;Female;health care quality;Humans;Intensive Care Units;Interviews as Topic;Length of Stay;Male;Neonatal/organization & administration;Palliative care;Palliative Care/organization & administration;Patient Care Planning/organization & administration;Pediatric intensive care unit;Pediatric/organization & administration;Pediatricians/psychology;Professional Family Relations;Qualitative Research

Description

BACKGROUND: Parents of children admitted to neonatal and pediatric intensive care units (ICUs) are at increased risk of experiencing acute and post-traumatic stress disorder. The integration of palliative care may improve child and family outcomes, yet there remains a lack of information about indicators for specialty-level palliative care involvement in this setting. OBJECTIVE: To describe neonatal and pediatric critical care physician perspectives on indicators for when and why to involve palliative care consultants. METHODS: Semistructured interviews were conducted with 22 attending physicians from neonatal, pediatric, and cardiothoracic ICUs in a single quaternary care pediatric hospital. Transcribed interviews were analyzed using content and thematic analyses. RESULTS: We identified 2 themes related to the indicators for involving palliative care consultants: (1) palliative care expertise including support and bridging communication and (2) organizational factors influencing communication including competing priorities and fragmentation of care. CONCLUSIONS: Palliative care was most beneficial for families at risk of experiencing communication problems that resulted from organizational factors, including those with long lengths of stay and medical complexity. The ability of palliative care consultants to bridge communication was limited by some of these same organizational factors. Physicians valued the involvement of palliative care consultants when they improved efficiency and promoted harmony. Given the increasing number of children with complex chronic conditions, it is important to support the capacity of ICU clinical teams to provide primary palliative care. We suggest comprehensive system changes and critical care physician training to include topics related to chronic illness and disability.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Citation List Month

November 2018 List

Pages

840-846

Issue

6

Volume

35

Collection

Citation

Richards CA;Starks H;O'Connor MR;Bourget E;Lindhorst T;Hays R;Doorenbos AZ, “When and Why Do Neonatal and Pediatric Critical Care Physicians Consult Palliative Care?,” Pediatric Palliative Care Library, accessed August 4, 2021, https://pedpalascnetlibrary.omeka.net/items/show/15624.

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