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Prevalence of specialised palliative care consultation for eligible children within a paediatric cardiac ICU

Published online by Cambridge University Press:  18 February 2021

Claudia Delgado-Corcoran Open the ORCID record for Claudia Delgado-Corcoran [Opens in a new window] ,
Erin E. Bennett ,
Stephanie A. Bodily ,
Sarah E. Wawrzynski ,
Danielle Green ,
Dominic Moore ,
Lawrence J. Cook  and
Lenora M. Olson
Claudia Delgado-Corcoran*
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, 84108, USA Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah, 100 N. Mario Capecchi Dr. Salt Lake City, UT, 84113, USA
Erin E. Bennett
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital. 1 Children’s Way, Little Rock, AR, 72202, USA
Stephanie A. Bodily
Affiliation:
Pediatric Critical Care Services, Primary Children’s Hospital, Intermountain Healthcare, 100 N. Mario Capecchi Dr. Salt Lake City, UT, 84113, USA
Sarah E. Wawrzynski
Affiliation:
Pediatric Critical Care Services, Primary Children’s Hospital, Intermountain Healthcare, 100 N. Mario Capecchi Dr. Salt Lake City, UT, 84113, USA
Danielle Green
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, 84108, USA
Dominic Moore
Affiliation:
Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah, 100 N. Mario Capecchi Dr. Salt Lake City, UT, 84113, USA
Lawrence J. Cook
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, 84108, USA
Lenora M. Olson
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, 84108, USA
*
Author for correspondence: Claudia Delgado-Corcoran, MD, MPH, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, 84108, USA. Tel: 801-599-0085; Fax: 801-662-2469. E-mail: Claudia.delgado@hsc.utah.edu
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Abstract

Objective:

Retrospectively apply criteria from Center to Advance Palliative Care to a cohort of children treated in a cardiac ICU and compare children who received a palliative care consultation to those who were eligible for but did not receive one.

Methods:

Medical records of children admitted to a cardiac ICU between January 2014 and June 2017 were reviewed. Selected criteria include cardiac ICU length of stay >14 days and/or ≥ 3 hospitalisations within a 6-month period.

Measurements and Results:

A consultation occurred in 17% (n = 48) of 288 eligible children. Children who received a consult had longer cardiac ICU (27 days versus 17 days; p < 0.001) and hospital (91 days versus 35 days; p < 0.001) lengths of stay, more complex chronic conditions at the end of first hospitalisation (3 versus1; p < 0.001) and the end of the study (4 vs.2; p < 0.001), and higher mortality (42% versus 7%; p < 0.001) when compared with the non-consulted group. Of the 142 pre-natally diagnosed children, only one received a pre-natal consult and 23 received it post-natally. Children who received a consultation (n = 48) were almost 2 months of age at the time of the consult.

Conclusions:

Less than a quarter of eligible children received a consultation. The consultation usually occurred in the context of medical complexity, high risk of mortality, and at an older age, suggesting potential opportunities for more and earlier paediatric palliative care involvement in the cardiac ICU. Screening criteria to identify patients for a consultation may increase the use of palliative care services in the cardiac ICU.

Keywords

Paediatricspalliative carecongenital heart defectsintensive care unitCenter to Advance Palliative Care
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 9 , September 2021 , pp. 1458 - 1464
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Abrahm, JL. American Academy of Hospice and Palliative Medicine: dedicated to Prevention and Relief of Suffering. J Oncol Practice 2006; 2: 191–192.CrossRefGoogle ScholarPubMed
Pantilat, SZ. Palliative care and hospitalists: a partnership for hope. J Hosp Med 2006. Online.CrossRefGoogle ScholarPubMed
Kuehn, BM. Hospitals embrace palliative care. JAMA 2007; September 19.Google ScholarPubMed
Feudtner, C, Friebert, S, Jewell, J. Pediatric palliative care and hospice care commitments, guidelines, and recommendations. Pediatrics 2013; 132: 966–972.Google Scholar
Renee, B, Judith, N, David, W, et al. Integrating Palliative Care into the Pediatric Intensive Care Unit. A Report from the IPAL-ICU (Improving Palliative Care in the ICU) Advisory Board. Pediatr Crit Care Med 2014; 15: 762–767.Google Scholar
Mazwi, ML, Henner, N, Kirsch, R. The role of palliative care in critical congenital heart disease. Semin Perinatol 2017; 41: 128–132.CrossRefGoogle ScholarPubMed
Morell, E, Moynihan, K, Wolfe, J, et al. Palliative care and paediatric cardiology: current evidence and future directions. Lancet Child Adolesc Health 2019; 3: 502–510.CrossRefGoogle ScholarPubMed
Friedrichsdorf, SJ, Postier, A, Dreyfus, J, et al. Improved Quality of Life at End of Life Related to Home-Based Palliative Care in Children with Cancer. J Palliat Med 2015; 18: 143–150.CrossRefGoogle ScholarPubMed
Temel, JS, Greer, JA, El-Jawahri, A, et al. Effects of early integrated palliative care in patients with lung and GI cancer: A randomized clinical trial. J Clin Oncol 2017; 35: 834–841.CrossRefGoogle ScholarPubMed
El-Jawahri, A, Greer, JA, Pirl, WF, et al. Effects of Early Integrated Palliative Care on Caregivers of Patients with Lung and Gastrointestinal Cancer: A Randomized Clinical Trial. Oncologist 2017; 22: 1528–1534.CrossRefGoogle ScholarPubMed
Richards, CA, Starks, H, O’Connor, MR, et al. When and Why Do Neonatal and Pediatric Critical Care Physicians Consult Palliative Care?. Am J Hosp Palliat Care 2018; 35: 840–846.CrossRefGoogle ScholarPubMed
Ciriello, AG, Dizon, ZB, October, TW. Speaking a Different Language: A Qualitative Analysis Comparing Language of Palliative Care and Pediatric Intensive Care Unit Physicians. Am J Hosp Palliat Care 2018; 35: 384–389.CrossRefGoogle ScholarPubMed
Delgado-Corcoran, C, Wawrzynski, SE, Bennett, EE, et al. Palliative Care in Children with Heart Disease Treated in an ICU. Pediatr Crit Care Med 2020; 21: 423–429.CrossRefGoogle Scholar
Friebert, S, Osenga, K. Pediatric palliative care referral criteria. Pediatric palliative care referral criteria Center to Advance Palliative Care 2009.Google Scholar
Feudtner, C, Feinstein, JA, Zhong, W, et al. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr 2014; 14: 199.CrossRefGoogle ScholarPubMed
Jenkins, KJ. Risk adjustment for congenital heart surgery: the RACHS-1 method. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 2004; 7: 180–184.CrossRefGoogle ScholarPubMed
Blinderman, CD, Billings, JA. Comfort Care for Patients Dying in the Hospital. N Engl J Med 2015; 373: 2549–2561.CrossRefGoogle ScholarPubMed
Trowbridge, A, Walter, JK, McConathey, E, et al. Modes of death within a children’s hospital. Pediatrics 2018; 142.CrossRefGoogle ScholarPubMed
Bogetz, JF, Ullrich, CK, Berry, JG. Pediatric hospital care for children with life-threatening illness and the role of palliative care. Pediatr Clin North Am 2014; 61: 719–733.CrossRefGoogle ScholarPubMed
Edwards, JD, Houtrow, AJ, Vasilevskis, EE, et al. Chronic conditions among children admitted to U.S. pediatric intensive care units: their prevalence and impact on risk for mortality and prolonged length of stay*. Crit Care Med 2012; 40: 2196–2203.CrossRefGoogle ScholarPubMed
Ananth, P, Melvin, P, Feudtner, C, et al. Hospital Use in the Last Year of Life for Children with Life-Threatening Complex Chronic Conditions. Pediatrics 2015; 136: 938–946.CrossRefGoogle ScholarPubMed
Goloff, N, Joy, BF. A part of the team: the changing role of palliative care in congenital heart disease. Prog Pediatr Cardiol 2018.CrossRefGoogle Scholar
Keele, L, Keenan, HT, Sheetz, J, et al. Differences in characteristics of dying children who receive and do not receive palliative care. Pediatrics 2013; 132: 72–78.CrossRefGoogle Scholar
Hancock, HS, Pituch, K, Uzark, K, et al. A randomised trial of early palliative care for maternal stress in infants prenatally diagnosed with single-ventricle heart disease. Cardiol Young 2018; 28: 561–570.CrossRefGoogle ScholarPubMed
Lowenstein, S, Macauley, R, Perko, K, et al. Provider perspective on the role of palliative care in hypoplastic left heart syndrome. Cardiol Young 2020; 30: 377–382.CrossRefGoogle ScholarPubMed
Hui, D, Mori, M, Meng, YC, et al. Automatic referral to standardize palliative care access: an international Delphi survey. Support Care Cancer 2018; 26: 175–180.CrossRefGoogle Scholar
Nelson, JE, Curtis, JR, Mulkerin, C, et al. Choosing and using screening criteria for palliative care consultation in the ICU: a report from the Improving Palliative Care in the ICU (IPAL-ICU) Advisory Board. Crit Care Med 2013; 41: 2318–2327.CrossRefGoogle ScholarPubMed
Morrison, WE, Gauvin, F, Johnson, E, et al. Integrating Palliative Care Into the ICU: from Core Competency to Consultative Expertise. Pediatr Crit Care Med 2018; 19 (8S Suppl 2): S86–S91.CrossRefGoogle ScholarPubMed
Hartjes, TM, Meece, L, Horgas, A. Implementing palliative care in the ICU. Nurs Crit Care 2014; 9 (4): 17–22.CrossRefGoogle Scholar
Zalenski, RJ, Jones, SS, Courage, C, et al. Impact of Palliative Care Screening and Consultation in the ICU: A Multihospital Quality Improvement Project. J Pain Symptom Manage 2017; 53: 5–12.e3.CrossRefGoogle ScholarPubMed
Adler, K, Schlieper, D, Kindgen-Milles, D, et al. Will your patient benefit from palliative care? A multicenter exploratory survey about the acceptance of trigger factors for palliative care consultations among ICU physicians. Intensive Care Med 2019; 45: 125–127.CrossRefGoogle ScholarPubMed
Mathews, KS, Nelson, JE. Palliative care in the ICU of 2050: past is prologue. Intensive Care Med 2017; 43: 1850–1852.CrossRefGoogle ScholarPubMed
Humphrey, L, Schlegel, A, Seabrook, R, et al. Trigger Criteria to Increase Appropriate Palliative Care Consultation in the Neonatal Intensive Care Unit. Pediatr Qual Saf 2019; 4: e129. Published 2019 Feb 7.CrossRefGoogle ScholarPubMed
Moynihan, KM, Snaman, JM, Kaye, EC, et al. Integration of Pediatric Palliative Care into Cardiac Intensive Care: A Champion-Based Model. Pediatrics 2019; 144: e20190160.CrossRefGoogle ScholarPubMed