Claire A Richards1,2, Helene Starks1,3, M Rebecca O'Connor4, Erica Bourget5, Taryn Lindhorst6, Ross Hays3,7,8,9,10, Ardith Z Doorenbos7,11,10,12. 1. 1 Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA. 2. 2 Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA. 3. 3 Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA. 4. 6 Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA. 5. 7 Department of Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 6. 8 School of Social Work, University of Washington, Seattle, WA, USA. 7. 4 Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA. 8. 10 Palliative Care Program, Seattle Children's Hospital, Seattle, WA, USA. 9. 11 The Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA. 10. 12 Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA. 11. 5 Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA. 12. 13 Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
Abstract
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.
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.
Entities:
Keywords:
care coordination; complex chronic conditions; critical care; family; health-care quality; palliative care; pediatric intensive care unit
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