An Automatic Pediatric Palliative Care Consultation for Children Supported on Extracorporeal Membrane Oxygenation: A Survey of Perceived Benefits and Barriers.

Abstract

<b><i>Background:</i></b> Pediatric palliative care (PPC) consultation is infrequent among children on extracorporeal membrane oxygenation (ECMO). <b><i>Objective:</i></b> Investigate intensive care unit (ICU) team members' perceptions of automatic PPC consultation for children on ECMO in an ICU in the United States. <b><i>Methods:</i></b> Cross-sectional survey assessing benefits, barriers to PPC, and consultation processes. <b><i>Results:</i></b> Of 291 eligible respondents, 48% (<i>n</i> = 140) completed the survey and 16% (<i>n</i> = 47) answered an open-ended question. Benefits included support in decision-making (<i>n</i> = 98; 70%) and identification of goals of care (<i>n</i> = 89; 64%). Barriers included perception of giving up on families (<i>n</i> = 59; 42%) and poor acceptability by other team members (<i>n</i> = 58; 41%). Respondents endorsed communication with the primary ICU team before (<i>n</i> = 122; 87%) and after (<i>n</i> = 129; 92%) consultation. Open-ended responses showed more positive (79% vs. 13%) than negative statements. Positive statements reflected on expanding PPC to other critically-ill children where negative statements revealed unrecognized value in PPC. <b><i>Conclusions:</i></b> Results demonstrate opportunities for education about the scope of PPC and improvements in PPC delivery.