Discussion
Palliative care is a recognized specialty encompassing an intradisciplinary team. Justification for funding such a high-level service can initially be challenging and may not be welcomed by teams unfamiliar with newer definitions of PC and who may not recognize the need for the service. A successful pediatric PC program has been developed without a dedicated physician initially and at relatively low cost. This comprehensive and robust pediatric PC program was established exclusively with allied health care staff and has established a pathway for a dedicated specialty team.
The concepts key to PC can be rolled into the practice of all health care professionals. As an example, a pediatric chaplain who is passionate about antenatal decision-making opportunities incorporates PC principles into her role as a chaplain, meeting with families at this difficult time to help develop birth plans in collaboration with high-risk obstetrics, NICU, and PC. By comprehensively training staff from diverse clinical backgrounds in PC principles, this incorporation of a more formal skill allows for infiltration of PC principles to the bedside and improves acceptance of a still foreign concept through a trusted clinician. Through education, involved professionals will continue to emphasize that PC does not equal end-of-life care. This further training is being ensured by inviting residents to rotate through PC as an elective and by incorporating PC into the orientation of all newly hired nursing, social work and chaplain staffs.
This service has found that there are areas where PC likely needs a modified structure/approach or new service creation: the emergency department, as well as the comprehensive coordination of care for children with complex, chronic conditions in the outpatient setting, PC as primary care providers or coordinators of care for children with multiple subspecialists. Bereavement support as a formal process needs to be broadened to include a CLS to provide support for siblings and children who lose adult loved ones as well as children. The limited community-based bereavement support groups are currently used with hopes for future development.
Further demonstrating the benefit of community collaboration, a pediatric PC board-certified MD has been hired by the community PC/hospice agency, and this hospital will contract for 0.6 FTE of the MD's time. This model will allow the MD to provide valuable service to inpatients and continue to follow them as an outpatient. The MD will also be able to further the development of the team and to provide clinical leadership for medical residents and a PC fellow.