Evaluation of a Quality Improvement Intervention to Improve Pediatric Palliative Care Consultation Processes

Abstract

Background: A critical aspect of pediatric palliative care consultations is the assessment and documentation of patient and family needs. While these assessments usually include a focus on physical pain, there is less standardization of assessments of other physical symptoms and psychosocial, emotional, or spiritual needs. Aims: To improve the breadth of assessment of psychosocial and emotional needs, screen for symptoms other than pain among pediatric patients utilizing palliative care services, and to increase documentation of assessment data from 30%-40% to 80% through practice changes implemented in 2 Plan-Do-Study-Act (PDSA) cycles. Methods: This quality improvement project involved implementing provider education and adapting the palliative care consultation template in the electronic health record to improve breadth and consistency of assessment and documentation during consultations by the interdisciplinary pediatric palliative care team. Two PDSA cycles were performed. Chi squared tests and statistical control charts were used for data analysis. Results: There was statistically significant improvement in the inclusion of documentation of a pediatric palliative care social work note from baseline (32%) to Cycle 2 (57%). Physical symptom screening declined slightly, but not significantly (p = .32) and socio-emotional discussions also declined but not significantly (p = .05). Conclusions: Screening for physical symptoms and discussions with patients and families about psychosocial/emotional needs during the initial palliative care consultations are extremely important in providing effective, holistic, patient-centered care. There is a need for development of pediatric-centric guidelines and quality measures to evaluate pediatric palliative care programs; further research is indicated to determine methods for evaluating compliance with these guidelines.

Paediatric oncologists’ perspectives on Strategic solutions to develop Integrated Cancer Palliative Care: feedback intervention theory as an explanatory Framework

“…High-yield palliative care referral triggers do not necessitate translation into practice, and incorporating these triggers into a screening scale might improve referral [ 17 ]. This argument is supported by evidence that suggests screening scales [ 18 – 20 ], referral criteria [ 21 ], care algorithms [ 22 ], standardising practices [ 23 ] and periodic audits [ 24 ] have the potential to enhance integrated paediatric palliative care. Three studies from the United States showed that embedding palliative care providers in paediatric oncology settings was feasible, acceptable, and improved child and family outcomes [ 25 – 27 ].…”

Optimizing resource utilization: palliative care consultations in critically ill pediatric trauma patients

“…[15][16][17] The literature on quality improvement and resource utilization of pediatric palliative care initiatives focuses on chronic illnesses, particularly the pediatric oncology population. [18][19][20] One single-center study of 167 patients aged 0-25 years with acute life-threatening illness or injury in the absence of complex chronic conditions showed that palliative care was involved in 20% of these patients' care and were able to provide earlier goals of care discussions and documentation of end-oflife preferences. 21 Our pilot study is the first quality improvement project specifically focused on a population of pediatric and adolescent trauma patients.…”

Reframing Patient Experience Approaches and Methods to Achieve Patient-Centeredness in Healthcare: Scoping Review

“…After screening the title and abstract of 6183 papers (excluding duplicates) for relevance to the subject, 131 papers were selected. A total of 67 articles [ 1 , 7 , 12 , 13 , 14 , 15 , 16 , 17 , 21 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , …”