Thread by @drgregkelly

Palliative & end of life care is a small but critically important part of #pedsICU

Our community has the knowledge & skills that our patients need but we lack simple & robust frameworks

My talk on #pedsPC at @worldcongressic #WCIC19

@worldcongressic Few kids die but they die after long battles, with chronic illnesses & in hospital or #pedsICU

¾ kids who die in PICU do after WLST

= palliative care in the PICU is inextricably linked with care in the PICU, & we are the best ppl to manage it

#pedsPC #WCIC19 @worldcongressic

@worldcongressic A simple & robust framework for palliative care in the #pedsICU

1. See clearly (use benefits vs burdens)
2. Build professional consensus
3. Create shared understanding w family
4. Offer active palliative care

#pedsPC #WCIC19 @worldcongressic

@worldcongressic Benefits vs burdens works best in palliative care

Benefits vs burdens for THIS patient, THIS treatment, THIS time

'Futile' treatments can keep patients alive (not futile). 'Best interests' can seem paternalistic or antagonistic

#pedsPC #pedsICU #WCIC19 @worldcongressic

@worldcongressic Professional consensus matters bc desperate parents of sick #pedsICU patients sense dissent & uncertainty amongst our team

1. Consult broadly
2. Help colleagues move beyond a contract of cure
3. Encourage clear vision with benefits vs burdens

#pedsPC #WCIC19 @worldcongressic

@worldcongressic Create shared understanding with #pedsICU families in palliative care situations

1. Always let the family talk first, they will tell you where they're at - if you let them
2. Clarify facts w words & pictures
3. Then create shared understanding

#pedsPC #WCIC19 @worldcongressic

@worldcongressic Offer ACTIVE palliative care to dying #pedsICU patients

Parents want every care, attention & consideration, not 'everything'

Plan your palliative care like you plan your other therapies

Establish family's wishes & redirect hope

#pedsPC #WCIC19 @worldcongressic