Pediatric Palliative Care and the PICU: Where We Have Been and Where We Are Going

Purpose of Review: This review provides pediatric intensivists and other pediatric clinicians a review of pediatric palliative care, focusing on its integration into the pediatric intensive care unit (PICU) and outlining vital skills for the intensivist. Recent Findings: Pediatric palliative care is a relatively young but growing field and is becoming increasingly available at many children’s hospitals. However, there has been a shortage of palliative care physicians historically (Lupu, J Pain Symptom Manag. 40(6):899–911, 2010). Palliative care teams are multidisciplinary and focus on assisting the PICU with pain and symptom management, communication with families, goals of care discussions, complicated grief, and bereavement. Palliative care team involvement may prolong life, improve quality of life by addressing physical and psychological suffering, decrease lengths of hospital and intensive care stay, and improve hospital wide resource utilization. Many PICU patients may benefit from palliative care services. All providers, including pediatric intensivists, should be able to perform primary, or basic, palliative care, including evaluating symptoms and communicating about goals of care and end of life (Hughes and Smith, Annu Rev Public Health. 35:459–475, 2014). More advanced secondary and tertiary palliative care relies on specialists to help navigate more nuanced communications and symptom management (Hughes and Smith, Annu Rev Public Health. 35:459–475, 2014). Summary: Palliative care has been shown to have great benefits for patients across the spectrum of diagnoses and prognoses. All providers, including intensivists, should have formalized training in primary palliative care. Mastering and incorporating primary palliative care skills into the clinical practice of non-palliative care providers will facilitate its delivery to patients.