Provider Perspectives on Palliative and Complex Care Team Collaboration

Abstract

Context: Pediatric palliative care and complex care programs frequently collaborate when caring for a shared population of children with medical complexity (CMC), despite programmatic heterogeneity across institutions. Yet, scant literature exists documenting the nature of collaboration between these subspecialties.

Objectives: The aim of the present study is to explore perceived facilitators and challenges to collaboration among pediatric complex care and palliative care providers within a subset of Midwest medical institutions.

Methods: Eighteen pediatric complex care and palliative care providers across ten academic medical centers completed semi-structured interviews. In addition to perceived facilitators and challenges, providers were asked to comment on hypothetical changes they would make to enhance future collaboration. Audio recordings were transcribed and qualitatively analyzed using thematic analysis.

Results: Qualitative analysis of provider commentary revealed individual and institution-level facilitators and challenges to collaboration between both teams, descriptions of the collaborative process when facilitators are optimized, and visions for enhancing future collaboration.

Conclusion: Participant responses from both subspecialties identified similar facilitators and challenges to collaboration, and supported greater integration as a means of mitigating collaborative challenges, offering ideas such as embedded programs, shared staff, or merging of divisions, among other interdisciplinary care models Future research is needed to explore methods of capturing outcomes associated with different integrative models, ideally through the incorporation of patient and family voices as a means of evaluating how clinical care is received.

Keywords: Complex care; children with medical complexity; palliative care; pediatrics.