RT Journal Article
SR Electronic
T1 Primary palliative care integrated model in paediatric ICU: an international cross-sectional study
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP bmjspcare-2020-002627
DO 10.1136/bmjspcare-2020-002627
A1 Grunauer, Michelle
A1 Mikesell, Caley
A1 Bustamante Callejas, Gabriela
YR 2021
UL http://spcare.bmj.com/content/early/2022/04/26/bmjspcare-2020-002627.abstract
AB Objectives Numbers are rising of chronically and critically ill, technology-dependent children, who are admitted to paediatric intensive care units (PICUs). An integrated model of care (IMOC), that combines paediatric critical care and primary paediatric palliative care (PPC), in which either approach varies depending on the disease trajectory and is provided by the critical care team, might be a fundamental component of the best available standard of care for patients with life-threatening conditions. The objective of this study is to assess how PICUs around the world, implement an IMOC.Methods International multicentre cross-sectional observational study. Data was gathered from 34 PICUs from 18 countries in the Americas, Europe, Asia and Africa. Provision of primary PPC was studied for each child admitted at the PICU. We evaluated score differences in each domain of the Initiative for Paediatric Palliative Care (IPPC) curriculum with multilevel generalised linear models.Results High-income country (HIC) units made up 32.4% of the sample, upper-middle income countries (UMICs) 44.1%, lower-middle income/lower income countries (LMIC/LICs) 23.5%. HICs had four statistically significantly higher IPPC scores compared with UMICs (domains: 1 holistic care; 2 family support, 3B family involvement; 6B grief/bereavement healthcare provider support) and two compared with LMIC/LICs (domains: 6A grief/bereavement family support; 6B grief/bereavement healthcare provider support).HICs had a statistically significant overall higher IPPC score than UMICs. Adjusting for patient/centre characteristics, shorter shifts and multiple comorbidities were associated with higher IPPC scores.Conclusions All centres offered some PPC provision and partially applied an IMOC. These results are encouraging, however, differences related to income and patients/unit evidence opportunities for improvement.Trial registration number ISRCTN12556149.Data are available upon reasonable request. DATA AVAILABILITY STATEMENT: Only MG, CM, and GB had access to the full dataset prior to publication. Data that could lead to the identification of patients was never collected. Study protocol, statistical analysis plan, and questionnaire data related to unit infrastructure and models of care will be made available to the PICU-MIC research group upon request and after reviewing the research proposal. Data will be made available to other researchers upon reasonable request and consent from the PICU-MIC research group. Data will be destroyed according to discipline standards after 10 years. Data is stored on password-protected computers only available to the MG, CM, and GB. Data requests can be made by emailing the corresponding author.