Background:
In a tertiary‐care setting, the culture of curative medicine can prevent physicians and parents from initiating a palliative medicine consult. Children who most need the service are those with chronic complex disease who have experienced multiple admissions and inpatient and outpatient encounters with numerous specialists. These patients have needs that are often overlooked, with heartbreaking consequences, and their parents may become overwhelmed by medical information and feel unable to make informed decisions. Establishing a trusting relationship with the palliative medicine team upstream of the patient's condition worsening is difficult. Furthermore, not all palliative medicine providers have primary admission privileges.
Purpose:
The goal of the study was to create a unified team approach to care for patients who could profit from working with a palliative medicine team.
Description:
The pediatric palliative medicine and hospitalist teams are uniquely situated to partner in care of children with complex conditions by providing continuity of medical information across specialties and introducing palliative care early as a site‐neutral resource. The hospitalist team provides general inpatient care and is a natural partner in identifying the subset of patients who would benefit from palliative medicine consults. Hospitalists normalize consults to change the perception that palliative medicine is just about dying. Parents are advised to be admitted to the hospitalist service with specialists consulting and get the palliative medicine team, the clearinghouse for recommendations, with each admission.
Conclusions:
Parents have discovered this service is an unexpected treasure: 28 families benefited from the service in 2005. They gain partners in medical decision making and symptom control across the continuum of inpatient and outpatient care. They are pleased with having a familiar team working with them in an inpatient setting in a coordinated approach. They feel informed and assured that their views and insights are heard. If their child dies, they have had relationships with palliative medicine providers established early. Resident education is enhanced. This approach is remarkably well accepted by parents. Referrals to pediatric palliative medicine are facilitated by educating parents that they have this choice and teaching them what it can offer, but we need better marketing efforts to make this choice known to families, nurses, and providers. We have learned that nurses remain hesitant to suggest this to parents, worried they will offend physicians. Physicians remain hesitant because palliative medicine means they are “giving up.” Cobranding the hospitalist and palliative teams has alleviated some of the stigma of palliative care and resulted in better care for patients and families.
Author Disclosure:
M. Marks, None.