The FOOTPRINTS^SMModel of Pediatric Palliative Care

Abstract

Little is known about the optimal context in which to provide care for the more than 53,000 children who die each year in the United States. Poor training in pediatric palliative care contributes to care that is often fragmented and may neglect the physical, psychosocial, and spiritual needs of the child and family. Pediatric hospice care is frequently not available or not chosen by the family or health care providers. In response to a critical need to move beyond the disease oriented, hospital-based model with a lack of continuity between hospital and community-based medical services, we developed FOOTPRINTS, an innovative program of advanced care planning and care coordination. A continuity physician directs the treatment plan regardless of site of care. Staff members coordinate follow up and communication among hospital and community-based care providers. Spiritual support continues through bereavement. Education in the hospital and community supports provision of excellent palliative care by current providers. Satisfaction with this model of care has been high. More than 90% of health care providers and families perceived that the child and family needs as well as the health care provider needs were met by the advanced care planning process and written care plan. All continuity providers would refer another patient. The FOOTPRINTS program promotes quality of care and family and health care provider satisfaction with care. It has been developed to serve as a "best practice" model for care at life's end.

Pediatric Advance Directives: Parents’ Knowledge, Experience, and Preferences

“…27 Several studies looking specifically at advance care planning in pediatrics have reported the process to be helpful and beneficial to the family and child. [20][21][22][28][29][30][31][32] At the conclusion of our survey, most participants were offered a basic information sheet about the hospital' s Comfort and Palliative Care Team (CPCT) and a business card to contact the team. No respondents contacted the CPCT, which suggests that the parents or caregivers took the information without intention of following up with the CPCT, intended to follow-up but ultimately decided not to, or faced subsequent barriers arranging follow-up despite their intention to do so.…”

The needs of professionals in the palliative care of children and adolescents

“…The discomfort related to the term "palliative" and insufficient communication skills are well known difficulties or even barriers to the provision of PPC [4,5,24,30]. To overcome these, education in basic palliative care and communication skills in addition to PPC specialist support on site have been highlighted in previous studies [13,28]. Another reason for discomfort in communication about dying and death could also be related to moral distress on the part of the HCPs themselves [2,32]; however, to confirm the latter, a more detailed study approach would be needed.…”

“…coordination of care and symptom control), and to some degree the direct support and care of a child. This kind of support has been named 'consultation service' and has been described as a reasonable and cost-effective model of care by several groups [19,28,33,34]. With respect to pediatric subspecialties, the collaboration of specialized PPC teams and pediatric oncology, cardiology, neurology, metabolic diseases and PICUs in tertiary centers and the ongoing involvement of the specialist, e.g.…”

“…The interview guide (Table 1) was designed on the basis of international studies and reviews [3,9,15,17,20,28,29,31] and slightly modified for the additional interviews in Part 2. The questionnaire was pilot tested with three professionals and revised according to feedback.…”

Estudo da impressão plantar obtida durante o teste de Jack em crianças

“…[4][5][6] When unclear about the true interpretation of these data, we seek studies in literature that address these methods of analyzing plantar support in a scientific manner. [2][3][4][6][7][8][9][10][11][12][13][14][15] Some authors affirm that the plantar impression does not demonstrate the true condition of the medial longitudinal arch. However, the vast majority uses it as a method of direct evaluation of this parameter in epidemiological studies, in the assessment of normal feet, determination of normality criteria and even in flat foot classifications.…”