A Review of the Integrated Model of Care: An Opportunity to Respond to Extensive Palliative Care Needs in Pediatric Intensive Care Units in Under-Resourced Settings

Abstract

It is estimated that 6.3 million children who die annually need pediatric palliative care (PPC) and that only about 10% of them receive the attention they need because about 98% of them live in under-resourced settings where PPC is not accessible. The consultative model and the integrated model of care (IMOC) are the most common strategies used to make PPC available to critically ill children. In the consultative model, the pediatric intensive care unit (PICU) team, the patient, or their family must request a palliative care (PC) consultation with the external PC team for a PICU patient to be evaluated for special care needs. While the consultation model has historically been more popular, issues related to specialist availability, referral timing, staff’s personal biases, misconceptions about PC, and other factors may impede excellent candidates from receiving the attention they need in a timely manner. Contrastingly, in the IMOC, family-centered care, PC tasks, and/or PC are a standard part of the treatment automatically available to all patients. In the IMOC, the PICU team is trained to complete critical and PC tasks as a part of normal daily operations. This review investigates the claim that the IMOC is the best model to meet extensive PPC needs in PICUs, especially in low-resource settings; based on an extensive review of the literature, we have identified five reasons why this model may be superior. The IMOC appears to: (1) improve the delivery of PPC and pediatric critical care, (2) allow clinicians to better respond to the care needs of patients and the epidemiological realities of their settings in ways that are consistent with evidence-based recommendations, (3) facilitate the universal delivery of care to all patients with special care needs, (4) maximize available resources, and (5) build local capacity; each of these areas should be further researched to develop a model of care that enables clinicians to provide pediatric patients with the highest attainable standard of health care. The IMOC lays out a pathway to provide the world’s sickest, most vulnerable children with access to PPC, a human right to which they are entitled by international legal conventions.

Integration of Pediatric Palliative Care Into Cardiac Intensive Care: A Champion-Based Model

“…Several models have been employed through clinical initiatives to improve the quality and integration of PC in different clinical settings, each of which offers certain advantages and significant disadvantages, including barriers to implementation in the CICU (Table 1). 9,11,15,21,22,[61][62][63] Traditional practical approaches to ICU-based PC include consultative and integrative models. Given the challenges inherent to these models and recognizing that many patients may benefit from basic PC principles, clinicians and researchers in neonatal and adult ICU settings have recently advocated for a mixed model combining elements from both paradigms.…”

Primary palliative care integrated model in paediatric ICU: an international cross-sectional study

“…Furthermore, few units might have a dedicated palliative care team for the PICU due to a deficiency of trained professionals or because of an expected positive prognosis of most children that are admitted to the PICUs. 1 Despite this, children whose lives are at risk can benefit from a primary PPC approach that can be combined with critical care.…”

“…Palliative care (PC) is a human right [1][2][3] and a fundamental component of the best available standard of care for severely ill patients [1][2][3][4][5][6] and those with life-limiting or life-threatening conditions. 7 This multidisciplinary care treats and prevents suffering and is associated with improved quality of care and quality of life for patients and families.…”

“…1 5 In the less common integrated model of care, ICU providers identify and address primary PPC needs as they arise. 1 Studies directly comparing these models are limited, but the integrated model of care (IMOC) may better facilitate primary PPC delivery, build local PPC capacity, and make primary PPC available in under-resourced environments. 1 Building primary PPC capacity and providing an integrated model of care in paediatric ICUs (PICUs) depends on a chain of interventions, 2 including the development of evidence-based recommendations.…”

“…1 Studies directly comparing these models are limited, but the integrated model of care (IMOC) may better facilitate primary PPC delivery, build local PPC capacity, and make primary PPC available in under-resourced environments. 1 Building primary PPC capacity and providing an integrated model of care in paediatric ICUs (PICUs) depends on a chain of interventions, 2 including the development of evidence-based recommendations. An example is the Initiative for Paediatric Palliative Care (IPPC) curriculum, which was developed by the Institute of Patient and Family Centered Care for children with life-threatening conditions and their families (box 1).…”