The role of the emergency department in pediatric palliative care

Abstract

Objective: To explore pediatric emergency medicine healthcare providers’ perspectives regarding their role in pediatric palliative care. Methodology: A qualitative study was conducted at the CHU Sainte-Justine from January to April 2016. Four interdisciplinary semi-structured focus groups were held: three involved pediatric emergency medicine staff and one interviewed the pediatrics palliative care team. These focus groups were transcribed and analysed in full using NVivo v. 21 (QSR International Inc.) to identify nodes and codes, and facilitate the emergence of themes. Data analysis borrows concepts from grounded theory by using thematic analysis and theoretical sampling. Results: A first group involving 8 pediatric emergency medicine staff members raised several limitations to providing pediatric palliative care in the emergency department (ED). These limitations included the unsuitable physical environment, constrained time and resources, lack of knowledge about the patient and his underlying medical condition, difficulties communicating, with both the patient’s primary physicians and the patient’s parents, and deficient training. ED staff suggested their role included evaluating the clinical situation, listening to the patient and his family, trying to establish a trusting relationship, supporting the patient and his family, and organising a rapid admission to the ward. Disagreements were encountered about two different approaches in palliative care. Some healthcare providers believed a designated and specialised team should manage all patients in pediatric palliative care. Others suggested a transversal approach, in which all healthcare providers have a role to play in the care of pediatric palliative care patients. Conclusion: Several limitations and barriers have been identified to providing high quality pediatric palliative care in a pediatric ED. The ED’s role in caring for these patients remains controversial, and demonstrates two distinct philosophies for providing pediatric palliative care.