scholarly journals Evaluation of a Quality Improvement Intervention to Improve Pediatric Palliative Care Consultation Processes

2021 ◽  
pp. 104990912110266
Author(s):  
Jennifer Forsman Stoyell ◽  
Megan Jordan ◽  
Anne Derouin ◽  
Julie Thompson ◽  
Sarah Gall ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Improvement ◽  
Physical Symptoms ◽  
Pediatric Palliative Care ◽  
Family Needs ◽  
Emotional Needs ◽  
Improvement Project ◽  
Symptom Screening ◽  
Palliative Care Consultation ◽  
Care Consultation

Background: A critical aspect of pediatric palliative care consultations is the assessment and documentation of patient and family needs. While these assessments usually include a focus on physical pain, there is less standardization of assessments of other physical symptoms and psychosocial, emotional, or spiritual needs. Aims: To improve the breadth of assessment of psychosocial and emotional needs, screen for symptoms other than pain among pediatric patients utilizing palliative care services, and to increase documentation of assessment data from 30%-40% to 80% through practice changes implemented in 2 Plan-Do-Study-Act (PDSA) cycles. Methods: This quality improvement project involved implementing provider education and adapting the palliative care consultation template in the electronic health record to improve breadth and consistency of assessment and documentation during consultations by the interdisciplinary pediatric palliative care team. Two PDSA cycles were performed. Chi squared tests and statistical control charts were used for data analysis. Results: There was statistically significant improvement in the inclusion of documentation of a pediatric palliative care social work note from baseline (32%) to Cycle 2 (57%). Physical symptom screening declined slightly, but not significantly (p = .32) and socio-emotional discussions also declined but not significantly (p = .05). Conclusions: Screening for physical symptoms and discussions with patients and families about psychosocial/emotional needs during the initial palliative care consultations are extremely important in providing effective, holistic, patient-centered care. There is a need for development of pediatric-centric guidelines and quality measures to evaluate pediatric palliative care programs; further research is indicated to determine methods for evaluating compliance with these guidelines.

scholarly journals The pervasive relevance of COVID-19 within routine paediatric palliative care consultations during the pandemic: A conversation analytic study

2020 ◽  
Vol 34 (9) ◽  
pp. 1202-1219
Author(s):  
Katie Ekberg ◽  
Lara Weinglass ◽  
Stuart Ekberg ◽  
Susan Danby ◽  
Anthony Herbert
Keyword(s):  
Palliative Care ◽  
Conversation Analysis ◽  
Family Needs ◽  
Face To Face ◽  
Health And Wellbeing ◽  
Paediatric Palliative Care ◽  
Palliative Care Consultation ◽  
Child Patients ◽  
Care Consultation ◽  
Initial Peak

Background: The importance of caring for children with complex and serious conditions means that paediatric palliative care must continue during pandemics. The recent pandemic of Coronavirus Disease 2019 (COVID-19) provides a natural experiment to study health communication during pandemic times. However, it is unknown how communication within consultations might change during pandemics. Aim: This study, a sub-study of a larger project, aimed to examine real-world instances of communication in paediatric palliative care consultations prior to and during the COVID-19 pandemic to understand how clinicians and families talk about the pandemic. Design: Paediatric palliative care consultations prior to, during, and immediately following the initial peak of COVID-19 cases in Australia were video recorded and analysed using Conversation Analysis methods. Setting/participants: Twenty-five paediatric palliative care consultations (including face-to-face outpatient, telehealth outpatient and inpatient consultations) were video recorded within a public children’s hospital in Australia. Participants included 14 health professionals, 15 child patients, 23 adult family members and 5 child siblings. Results: There was a pervasive relevance of both serious and non-serious talk about COVID-19 within the consultations recorded during the pandemic. Topics typical of a standard paediatric palliative care consultation often led to discussion of the pandemic. Clinicians (55%) and parents (45%) initiated talk about the pandemic. Conclusions: Clinicians should not be surprised by the pervasiveness of COVID-19 or other pandemic talk within standard paediatric palliative care consultations. This awareness will enable clinicians to flexibly address family needs and concerns about pandemic-related matters that may impact health and wellbeing.

scholarly journals Components and Principles of a Pediatric Palliative Care Consultation: Results of a Delphi Study

2014 ◽  
Vol 17 (11) ◽  
pp. 1206-1213 ◽  
Author(s):  
Natalie Bradford ◽  
Anthony Herbert ◽  
Christine Mott ◽  
Nigel Armfield ◽  
Jeanine Young ◽  
...  
Keyword(s):  
Palliative Care ◽  
Delphi Study ◽  
Pediatric Palliative Care ◽  
Palliative Care Consultation ◽  
Care Consultation

scholarly journals A conceptual model of barriers and facilitators to primary clinical teams requesting pediatric palliative care consultation based upon a narrative review

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Jennifer K. Walter ◽  
Douglas L. Hill ◽  
Concetta DiDomenico ◽  
Shefali Parikh ◽  
Chris Feudtner
Keyword(s):  
Palliative Care ◽  
Conceptual Model ◽  
Treatment Plan ◽  
Research Literature ◽  
Pediatric Palliative Care ◽  
Palliative Care Consultation ◽  
Communication Challenges ◽  
Care Consultation ◽  
The Individual

Abstract Background Despite evidence that referral to pediatric palliative care reduces suffering and improves quality of life for patients and families, many clinicians delay referral until the end of life. The purpose of this article is to provide a conceptual model for why clinical teams delay discussing palliative care with parents. Discussion Building on a prior model of parent regoaling and relevant research literature, we argue for a conceptual model of the challenges and facilitators a clinical team might face in shifting from a restorative-focused treatment plan to a plan that includes palliative aspects, resulting in a subspecialty palliative care referral. Like patients and families, clinicians and clinical teams may recognize that a seriously ill patient would benefit from palliative care and shift from a restorative mindset to a palliative approach. We call this transition “clinician regoaling”. Clinicians may experience inhibitors and facilitators to this transition at both the individual and team level which influence the clinicians’ willingness to consult subspecialty palliative care. The 8 inhibitors to team level regoaling include: 1) team challenges due to hierarchy, 2) avoidance of criticizing colleagues, 3) structural communication challenges, 4) group norms in favor of restorative goals, 5) diffusion of responsibility, 6) inhibited expression of sorrow, 7) lack of social support, 8) reinforcement of labeling and conflict. The 6 facilitators of team regoaling include: 1) processes to build a shared mental model, 2) mutual trust to encourage dissent, 3) anticipating conflict and team problem solving, 4) processes for reevaluation of goals, 5) sharing serious news as a team, 6) team flexibility. Conclusions Recognizing potential team level inhibitors to transitioning to palliative care can help clinicians develop strategies for making the transition more effectively when appropriate.

Early palliative care involvement for children with cancer.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 26-26
Author(s):  
Laila Mahmood ◽  
Ann Dozier ◽  
James Dolan ◽  
Denise Casey ◽  
David Nathan Korones
Keyword(s):  
Palliative Care ◽  
Overall Survival ◽  
High Risk ◽  
Study Entry ◽  
Pediatric Palliative Care ◽  
Newly Diagnosed ◽  
Children With Cancer ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Care Consultation

26 Background: Although the overall survival of children with cancer exceeds 80%, these children experience significant physical, emotional, social and spiritual suffering. That suffering is even more profound for the 20% of children who succumb to their disease. We therefore conducted a prospective study to assess the feasibility and impact of early palliative care involvement for children with high risk malignancies. Objective: To determine if early palliative care involvement for high risk pediatric oncology patients is feasible, acceptable to patients, families and oncology teams, and helps with symptom management and communication. Methods: This was a prospective survey-based study. Children with cancer treated at University of Rochester were eligible to participate if they had a high risk malignancy, defined as (1) having a newly-diagnosed malignancy with an estimated overall survival of < 50%, (2) requiring hematopoietic stem cell transplantation (HSCT), and/or (3) any relapsed, recurrent or progressive cancer. Parents of these children or children >18YO were surveyed upon study entry, and 3 and 6 months later to assess the impact of early and ongoing pediatric palliative care involvement. Results: 20/25 eligible patients received a palliative care consultation at diagnosis; 16 families participated in the study. Six children had a newly diagnosed high risk malignancy, nine had recurrent disease and one child had a HSCT. Median age of the children was 5 years (0.1-20 year).The most frequent symptoms at the time of study entry were pain (75%), nausea/vomiting (69%), constipation (44%), and fatigue (44%). 75%, 73%, 43% and 43% reported successful treatment of pain, nausea/vomiting, constipation, and fatigue respectively. The proportion of children with each symptom decreased at 3 months except for fatigue. There was high satisfaction with the oncology and pediatric palliative care teams at baseline and 3 and 6 months. No families or oncologists declined an early palliative care consultation. Conclusions: Our results suggest that an early palliative care consultation is feasible for high risk children with cancer and that the palliative care team can work successfully with the primary oncology team to foster symptom control and communication.

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