In an article published in the Annals of Emergency Medicine in October 2019, a qualitative study sheds light on the crucial role of the pediatric emergency department (ED) in providing palliative care to children with medical complexity. The study, led by Anne-Josée Côté from the Department of Pediatrics, Montreal Children’s Hospital, Montreal, Quebec, Canada, and colleagues, underscores the challenges and potential strategies to improve care for these vulnerable patients.
Challenges and Emotion in Pediatric Palliative Care
Emergency departments are often the first contact point for critically ill children, necessitating a broad approach that balances acute medical interventions with palliative care principles. The study involved semistructured focus groups with 58 health care professionals from pediatric emergency medicine, palliative care, complex care, and intensive care units, held between January and October 2016. The discussions focused on their experiences and perspectives on delivering palliative care services in the pediatric ED.
The findings revealed that the culture of the ED itself, known for its fast-paced and high-intensity environment, poses significant challenges to providing palliative care. Health care professionals expressed strong emotional responses when treating children with life-limiting illnesses. The emergency setting is often geared towards life-saving interventions, which can conflict with the goals of palliative care, aimed at comfort and quality of life.
Another major challenge identified was the lack of continuity of care. Children with medical complexity often have intricate care pathways involving multiple specialists and care teams. This can disrupt the flow of crucial information about the child’s condition, treatment preferences, and palliation goals, leading to fragmented care during emergency situations.
Strategies for Integrating Palliative Care into the ED
The study suggested several strategies to enhance the provision of palliative care in the pediatric ED. Essential among these is the need for clear and empathetic communication with families, which allows for a shared understanding of the child’s prognosis and the family’s wishes.
Health care professionals should assess the clinical situation promptly while reaching out to other known care teams to gather information about established palliative care plans. It’s critical to create a caring environment for the child and family, one that alleviates distressing symptoms and offers the emotional support these situations demand.
Facilitating Collaborative Care
Increased communication between different health care teams emerged as a primary means of facilitating patient flow and improving care quality. The study highlighted the necessity for emergency care providers to be included in discussions about the palliation goals for complex pediatric patients well before an emergency arises.
It underscores the importance of training ED personnel in palliative care principles, promoting interdisciplinary teamwork, and ensuring that emergency staff has access to patients’ palliative care plans and the expertise of palliative care professionals.
Looking Ahead: Improving Pediatric Palliative Care
Providing high-quality pediatric palliative care in the ED is unquestionably complex, presenting unique challenges that require dedication and innovative solutions from all involved. But the study suggests optimism, noting that barriers can be overcome with concerted effort and structural changes within the health care system.
For the medical community, it means embracing a culture that allows for the integration of palliative care into emergency medicine, fostering a model of care that is compassionate, coordinated, and comprehensive. The goal is clear: to ensure that all children with life-limiting conditions receive the care they need when they are most vulnerable.
Relevance and Contribution to the Field
The study published in the Annals of Emergency Medicine represents a seminal contribution to our understanding of pediatric palliative care in emergency settings. It provides a platform for debate, policy formulation, and practice changes that could ultimately transform the care of children with complex medical needs.
References
DOI:
10.1016/j.annemergmed.2019.03.008
References:
1. Côté, A. J., Payot, A., & Gaucher, N. (2019). Palliative Care in the Pediatric Emergency Department: Findings From a Qualitative Study. Annals of Emergency Medicine, 74(4), 481-490.
2. Feudtner, C., Womer, J., Augustin, R., Remke, S., Wolfe, J., Friebert, S., & Weissman, D. (2013). Pediatric Palliative Care Programs in Children’s Hospitals: A Cross-Sectional National Survey. Pediatrics, 132(6), 1063-1070.
3. Knapp, C., Woodworth, L., Wright, M., Downing, J., Drake, R., Fowler-Kerry, S., Hain, R., & Marston, J. (2011). Pediatric Palliative Care Provision Around the World: A Systematic Review. Pediatric Blood & Cancer, 57(3), 361-368.
4. Mayer, M. L., Sandberg, S. F., & Pallotto, E. K. (2011). Innovations in Pediatric Palliative Care: A Qualitative Comparative Case Study. Qualitative Health Research, 21(8), 1061-1071.
5. The Committee on Bioethics of the American Academy of Pediatrics. (2000). Palliative Care for Children. Pediatrics, 106(2), 351-357.
Keywords
1. Pediatric Palliative Care
2. Emergency Department Challenges
3. Continuity of Care
4. Palliative Communication Strategies
5. Pediatric End-of-Life Care