%0 Journal Article %J J Palliat Med %D 2013 %T Examining palliative care team involvement in automatic consultations for children on extracorporeal life support in the pediatric intensive care unit. %A Doorenbos, Ardith Z %A Starks, Helene %A Bourget, Erica %A McMullan, D Michael %A Lewis-Newby, Mithya %A Rue, Tessa C %A Lindhorst, Taryn %A Aisenberg, Eugene %A Oman, Natalie %A Curtis, J Randall %A Hays, Ross %A Clark, Jonna D %A Baden, Harris P %A Brogan, Thomas V %A Di Gennaro, Jane L %A Mazor, Robert %A Roberts, Joan S %A Turnbull, Jessica %A Wilfond, Benjamin S %K Child %K Child, Preschool %K Extracorporeal Membrane Oxygenation %K Female %K Humans %K Infant %K Infant, Newborn %K Intensive Care Units, Pediatric %K Male %K Palliative Care %K Patient Care Team %K Prognosis %K Retrospective Studies %X

BACKGROUND: Extracorporeal life support (ECLS) is an advanced form of life-sustaining therapy that creates stressful dilemmas for families. In May 2009, Seattle Children's Hospital (SCH) implemented a policy to involve the Pediatric Advanced Care Team (PACT) in all ECLS cases through automatic referral.

OBJECTIVE: Our aim was to describe PACT involvement in the context of automatic consultations for ECLS patients and their family members.

METHODS: We retrospectively examined chart notes for 59 consecutive cases and used content analysis to identify themes and patterns.

RESULTS: The degree of PACT involvement was related to three domains: prognostic uncertainty, medical complexity, and need for coordination of care with other services. Low PACT involvement was associated with cases with little prognostic uncertainty, little medical complexity, and minimal need for coordination of care. Medium PACT involvement was associated with two categories of cases: 1) those with a degree of medical complexity but little prognostic uncertainty; and 2) those that had a degree of prognostic uncertainty but little medical complexity. High PACT involvement had the greatest medical complexity and prognostic uncertainty, and also had those cases with a high need for coordination of care.

CONCLUSIONS: We describe a framework for understanding the potential involvement of palliative care among patients receiving ECLS that explains how PACT organizes its efforts toward patients and families with the highest degree of need. Future studies should examine whether this approach is associated with improved patient and family outcomes.

%B J Palliat Med %V 16 %P 492-5 %8 2013 May %G eng %N 5 %R 10.1089/jpm.2012.0536 %0 Journal Article %J J Soc Work End Life Palliat Care %D 2012 %T Palliative care in the pediatric ICU: challenges and opportunities for family-centered practice. %A Doorenbos, Ardith %A Lindhorst, Taryn %A Starks, Helene %A Aisenberg, Eugene %A Curtis, J Randall %A Hays, Ross %K Child %K Humans %K Intensive Care Units, Pediatric %K Palliative Care %K Patient Care Team %K Patient Transfer %K Patient-Centered Care %K Pediatrics %K Professional Role %K Professional-Family Relations %K Terminal Care %K United States %X

The culture of pediatric intensive care units (PICUs) is focused on curative or life-prolonging treatments for seriously ill children. We present empirically-based approaches to family-centered palliative care that can be applied in PICUs. Palliative care in these settings is framed by larger issues related to the context of care in PICUs, the stressors experienced by families, and challenges to palliative care philosophy within this environment. Innovations from research on family-centered communication practices in adult ICU settings provide a framework for development of palliative care in PICUs and suggest avenues for social work support of critically ill children and their families.

%B J Soc Work End Life Palliat Care %V 8 %P 297-315 %8 2012 %G eng %N 4 %R 10.1080/15524256.2012.732461