Integration of Pediatric Palliative Care Into Cardiac Intensive Care: A Champion-Based Model

Katie M. Moynihan, Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children's Hospital Boston, Massachusetts.
Jennifer M. Snaman, Department of Pediatrics, Medical School, Harvard University, Boston, Massachusetts.
Erica C. Kaye, Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Wynne E. Morrison, Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of.
Aaron G. DeWitt, Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of.
Loren D. Sacks, Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California.
Jess L. Thompson, Department of Cardiothoracic Surgery, Children's Heart Center, University of Oklahoma, Oklahoma City, Oklahoma; and.
Jennifer M. Hwang, Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of.
Valerie Bailey, Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children's Hospital Boston, Massachusetts.
Deborah A. Lafond, PANDA Palliative Care Team, Children's National and School of Medicine, The George Washington University, Washington, District of Columbia.
Joanne Wolfe, Department of Pediatrics, Medical School, Harvard University, Boston, Massachusetts.
Elizabeth D. Blume, Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children's Hospital Boston, Massachusetts.

Abstract

Integration of pediatric palliative care (PPC) into management of children with serious illness and their families is endorsed as the standard of care. Despite this, timely referral to and integration of PPC into the traditionally cure-oriented cardiac ICU (CICU) remains variable. Despite dramatic declines in mortality in pediatric cardiac disease, key challenges confront the CICU community. Given increasing comorbidities, technological dependence, lengthy recurrent hospitalizations, and interventions risking significant morbidity, many patients in the CICU would benefit from PPC involvement across the illness trajectory. Current PPC delivery models have inherent disadvantages, insufficiently address the unique aspects of the CICU setting, place significant burden on subspecialty PPC teams, and fail to use CICU clinician skill sets. We therefore propose a novel conceptual framework for PPC-CICU integration based on literature review and expert interdisciplinary, multi-institutional consensus-building. This model uses interdisciplinary CICU-based champions who receive additional PPC training through courses and subspecialty rotations. PPC champions strengthen CICU PPC provision by (1) leading PPC-specific educational training of CICU staff; (2) liaising between CICU and PPC, improving use of support staff and encouraging earlier subspecialty PPC involvement in complex patients' management; and (3) developing and implementing quality improvement initiatives and CICU-specific PPC protocols. Our PPC-CICU integration model is designed for adaptability within institutional, cultural, financial, and logistic constraints, with potential applications in other pediatric settings, including ICUs. Although the PPC champion framework offers several unique advantages, barriers to implementation are anticipated and additional research is needed to investigate the model's feasibility, acceptability, and efficacy.

Publication Title

Pediatrics

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