ArticleInpatient Pediatric Palliative Care Consult Requests and Recommendations
Section snippets
INTRODUCTION
Pediatric palliative care (PPC), as described by the World Health Organization (2018), is the comprehensive care of a child facing a life-threatening illness, which includes caring for the child's body, mind, and spirit while also offering support to the child's family. The American Academy of Pediatrics (American Academy of Pediatrics Committee on Bioethics and Committee on Hospital Care, 2000) recommends that palliative care be introduced at diagnosis and continue throughout the child's
Setting
We conducted a retrospective cohort study deemed exempt from human subjects research by our institutional review board. Our institution is a free-standing, quaternary care, > 400-bed children's hospital with a 48-bed pediatric ICU, 24-bed cardiac ICU, and 83-bed neonatal ICU. Inpatient ward teams that consult PPC include hospital medicine, pulmonology, gastroenterology/hepatology, hematology/oncology, and nephrology. Consults are requested at the discretion of the primary teams, and the PPC
RESULTS
Of the 500 reviewed encounters, 327 encounters from 260 unique patients were eligible for inclusion (Figure). Demographic and clinical information for unique patients is presented in Table 1. Patients were a median age of 1 year (interquartile range, 0.0–11.0), 53.1% male, 70.9% White, and over 80% had public insurance. Seventy-eight percent of patients had four or more CCCs. Technology dependence, cardiovascular conditions, gastrointestinal conditions, and neurological/neuromuscular conditions
DISCUSSION
Our study demonstrates that patients in our system who received PPC consults were likely to be (1) highly complex with a wide variety of CCCs, (2) reliant on medical technology, and (3) covered by public insurance. Most PPC consults, especially those for new patients, were conducted for patients on ICU teams. Key differences were noted between ward and ICU consults in symptoms addressed and recommendations provided by the PPC team. Furthermore, differences between consults for new and
Kristin Carter, Pediatric Hospice and Palliative Medicine Fellow, Northwestern University Feinberg School of Medicine, Department of Pediatrics, Division of Palliative Care, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
References (21)
- et al.
Research Electronic Data Capture (REDCap)–A metadata-driven methodology and workflow process for providing translational research informatics support
Journal of Biomedical Informatics
(2009) - et al.
Pediatric palliative care consultation
Pediatric Clinics of North America
(2014) - et al.
Primary palliative care: Skills for all clinicians
Current Problems in Pediatric and Adolescent Health Care
(2020) Palliative care for children
Pediatrics
(2000)- et al.
Components and principles of a pediatric palliative care consultation: Results of a Delphi study
Journal of Palliative Medicine
(2014) - et al.
Pediatric oncology providers’ perceptions of barriers and facilitators to early integration of pediatric palliative care
Pediatric Blood and Cancer
(2013) - et al.
Barriers to palliative care for children: Perceptions of pediatric health care providers
Pediatrics
(2008) - et al.
Pediatric complex chronic conditions classification system version 2: Updated for ICD-10 and complex medical technology dependence and transplantation
BMC Pediatrics
(2014) - et al.
Deaths attributed to pediatric complex chronic conditions: National trends and implications for supportive care services
Pediatrics
(2001) - et al.
Pediatric palliative care patients: A prospective multicenter cohort study
Pediatrics
(2011)
Cited by (0)
Kristin Carter, Pediatric Hospice and Palliative Medicine Fellow, Northwestern University Feinberg School of Medicine, Department of Pediatrics, Division of Palliative Care, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Jennifer L. Raybin, Pediatric Palliative Care Program Leader, University of Colorado School of Medicine, Department of Pediatrics, Section of Palliative Care, Children's Hospital Colorado, Aurora, CO.
Lilliam Ambroggio, Associate Professor, Director of Research (Hospital Medicine), Associate Director of Research (Emergency Medicine), University of Colorado School of Medicine, Department of Pediatrics, Sections of Emergency Medicine and Hospital Medicine, Children's Hospital Colorado, Aurora, CO.
Mitchell Frydenlund, Medical Student, University of Colorado School of Medicine, Aurora, CO.
Jacob Thomas, Data Analyst, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, CO.
Kathryn Squiers, Clinical Associate, University of Chicago, Department of Pediatrics, Section of Pediatric Hospital Medicine, Comer Children's Hospital, Chicago, IL.
Mark Brittan, Associate Professor, Pediatric Hospital Medicine Fellowship Director, Associate Director of Research, University of Colorado School of Medicine, Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, CO.
This work was supported by the National Institutes of Health/National Center for Advancing Translational Sciences and the Colorado Clinical and Translational Sciences Institute (grant no. UL1 TR002535). Contents are the authors’ sole responsibility and do not necessarily represent official National Institutes of Health views. The funding agency did not have any involvement in the study design, in the collection, analysis, and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.
Conflicts of interest: None to report.
Kristin Carter has full access to the data and will provide access to the data on which the manuscript is based for examination by the editors or their assignees if requested.