PALLIATIVE CARE IN THE PEDIATRIC EMERGENCY DEPARTMENT: FINDINGS FROM A QUALITATIVE STUDY
Cote A, Payot A, Gaucher N. Ann Emerg Med. 2019;74(4):481-490.
The researchers in this qualitative study sought to explore challenges in providing palliative care for children in the emergency department (ED) and roles for the ED in caring for children with complex medical issues. A secondary aim of this study was to propose solutions for implementation of palliative care for children while they were in the ED. The researchers state that medically complex children who visit the ED are at risk of fragmented care related to issues with communication, care coordination, and case management. They further state that an acute event may change a family's preference with end-of-life care.
The researchers conducted semistructured interviews (n = 58) with health care professionals from the ED, palliative care, complex care, and intensive care to explore their perspective on palliative care in the ED. Some of the barriers reported in providing palliative care in the ED included ED's culture of care and emotions when caring for children with complex medical issues, continuity of care, pressures to be efficient, lack of expertise with pediatric palliative care, and discomfort with communication on palliative care with families of medically complex children.
The researchers found that communication between the teams was essential in providing care for these children including transmitting information on these children and their family's preference for end-of-life care. Study findings also included the necessity of preparing families and medically complex children for potential ED visits and the need to strengthen the relationship between the ED, the primary care providers, and case management.
CAREGIVER STRATEGY USE TO PROMOTE CHILDREN'S HOME PARTICIPATION AFTER PEDIATRIC CRITICAL ILLNESS
Jarvis JM, Gurga AR, Lim H, et al. Arch Phys Med Rehabil. 2019;100:2144-2150.
In this qualitative substudy of a Wee-Cover prospective cohort study, the aim of this study was to assess the most common type of caregiver strategy to support their child's home participation after a critical illness. A secondary aim was to identify strategy use for caregivers of children who did and did not receive pediatric intensive care unit (PICU) rehabilitation services. This study included Wee-Cover caregivers (n = 180) of patients aged 1 to 17 years of age who were admitted to the PICU for >= 48 hours.
Data were obtained from open-ended questions on strategies with the Participation and Environment Measure at PICU discharge and 3 and 6 months after PICU discharge. Strategies were classified as either remedial or compensatory. Data on PICU-based rehabilitation services were obtained from electronic medical records. The researchers found that most caregiver strategies were compensatory, with 60% of these strategies used toward fostering a supportive relationship. They also found strategies addressing the child's natural environment (12%), services (3%), and attitudes of others in the home (1%). The results were similar for children who received PICU rehabilitation services and for those who did not.
The researchers concluded potentially important areas of educational needs that can assist the caregivers' education practices as part of their child's rehabilitation needs near or at discharge from the PICU.