Palliative Care in the Pediatric Emergency Department: Findings From a Qualitative Study - 19/09/19
, Antoine Payot, MD, PhD b, d, Nathalie Gaucher, MD, PhD cAbstract |
Study objective |
Children with medical complexity represent a fragile population and account for the majority of patients followed in pediatric palliative care. Little is known in regard to the role of the emergency department (ED) in caring for the families of children with medical complexity.
Methods |
Semistructured focus groups were held with health care professionals from pediatric emergency medicine, palliative care, complex care, and intensive care to explore their perspective on pediatric palliative care in the ED. Data were transcribed and analyzed with NVivo software, and thematic analysis and theoretic sampling were performed.
Results |
From January to October 2016, 58 participants were interviewed. Difficulties providing pediatric palliative care in the ED are related on the one hand to characteristics specific to the ED, such as its culture and its health care professionals’ strong emotional responses when caring for children with medical complexity, and on the other hand to factors extrinsic to the ED; mainly, lack of continuity of care. For critically ill children with unknown goals of care and potential for end of life, professionals in the ED should evaluate the clinical situation, contact known health care teams, remain open to families’ preferences, alleviate distressing symptoms, and create a caring environment. Communication between teams is targeted by health care professionals to facilitate and improve patient flow and care.
Conclusion |
Although perspectives differ in regard to how to provide care for pediatric palliative care patients in the ED, several barriers to providing high-quality emergency pediatric palliative care can be overcome.
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| Please see page 482 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Kathy N. Shaw, MD, MSCE. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: All authors conceived the study, designed the research protocol, applied for funding, and participated in data analysis. A-JC and NG were responsible for participant recruitment and data collection and contributed to dissemination of knowledge in different meetings. AP supervised participant recruitment. A-JC drafted the article and all authors contributed substantially to its revision. A-JC takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This work was supported by a grant from the Hubert Doucet Scholarship. |
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Vol 74 - N° 4
P. 481-490 - octobre 2019 Retour au numéro
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