Communication Strategies & Palliative Care in the PICU--Part 1
Sep 5, 2022
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Pediatric palliative care specialists discuss the definition of palliative care, the importance of early involvement, and debunk misconceptions about hospice care. They share their approach to communicating with families in challenging cases, emphasizing listening, humility, and being forthright. The chapter also covers general principles and guidelines for involving palliative care in seriously ill patients, and provides tips for communicating with families in different clinical scenarios.
20:57
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Quick takeaways
Palliative care focuses on providing comprehensive support for children and their families, addressing not only physical burdens but also emotional, spiritual, and psychosocial challenges.
Early involvement of palliative care in children with complex chronic diagnoses or facing new diagnoses can improve communication, build trust, and ensure families feel heard and supported.
Deep dives
Introduction to Palliative Care
Palliative care is often misunderstood as being synonymous with end-of-life or hospice care. However, palliative care focuses on providing support and relieving the burdens of disease, regardless of whether the child is approaching the end of life. This includes addressing not only physical burdens but also emotional, spiritual, and psychosocial challenges faced by the child and their family. The goal is to provide comprehensive care and improve the quality of life for the child.
When to Involve Palliative Care
Palliative care should be involved early in the care of children with complex chronic diagnoses or those facing new diagnoses. It can provide support in managing symptoms, facilitating communication between healthcare teams and families, and helping with difficult decision-making. Organizations like CAPC provide specific referral criteria, which include cases such as prolonged mechanical ventilation, multi-organ system failure, irreversible brain injury, or extended PICU stays. Involving palliative care early can foster better communication, build trust, and ensure that families feel heard and supported.
Introducing Palliative Care to Families
Introducing palliative care to families can be emotionally charged, but it is important to address their fears and concerns. Palliative care team members can present themselves as an additional layer of support, listening to families' experiences, managing symptoms, facilitating communication, and advocating for their needs. Metaphors such as sitting on their side of the table to ensure their voice is heard and helping them read the map of medical decisions can help families understand the role of palliative care. Early involvement and open conversation about the possibilities and uncertainties can ease the transition and prepare families for difficult decisions.
Verbalize a more progressive definition of palliative care, and distinguish it from "end-of-life" care or hospice care.
Define appropriate patient populations for referral to palliative care.
Sensitively and clearly introduce palliative care referral with patients and families.
Recognize the value of communication training, and verbalize a simple framework for difficult conversations.
Define the challenges of learning/practicing difficult communication as a resident/fellow, and elaborate some strategies to help mitigate these challenges.
About our guests:
Stockton Beveridge, M.D., is an Assistant Professor in the Department of Pediatrics in the Division of Developmental / Behavioral Pediatrics, serving as the director of Pediatric Palliative Care. Dr. Beveridge’s research interests have focused on the challenges faced by caregivers of children with medical complexity, particularly in the Latino population. He is additionally interested in the intersection of religion and medicine, particularly in medical crisis. He sits on the hospital’s Ethics Committee and is also the medical director for Schwartz Rounds.
Katie Maddox, M.D., is an Assistant Professor in the Department of Pediatrics in the Division of Developmental / Behavioral Pediatrics at UT Southwestern. She is a board-certified pediatric palliative care physician at Children’s Health Dallas. Her clinical and research interests relate to caring for children with special healthcare needs and communication skills training in medical education. Dr. Maddox has received the Educational Innovation Award for developing communication skills training and the Pediatric Society of Greater Dallas White Hat Award.
References:
Center to Advance Palliative Care--https://www.capc.org/
Childers JW, Back AL, Tulsky JA, Arnold RM. REMAP: A Framework for Goals of Care Conversations. J Oncol Pract. 2017 Oct;13(10):e844-e850. doi: 10.1200/JOP.2016.018796. Epub 2017 Apr 26. PMID: 28445100.
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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