Confronting Adversity through Regoaling Engagement (CARE) Project

Children with advanced cancer are often not referred to palliative or hospice care before they die or are only referred close to the time of death. The Confronting Adversity through Regoaling Engagement (CARE) consisted of four stages:

Resources

Stage 1:

We observed clinical team meetings and conducted interviews with individual interprofessional team members at the Children’s Hospital of Philadelphia (CHOP) to characterize team discussions about patients appropriate for initiation of palliative care in three oncology subspecialties (Bone Marrow Transplant (BMT), Solid Tumor and Neuro-Oncology) and to assess interprofessional team member perceptions of initiation of palliative care and subspeciality palliative care consultations.

Szymczak et. al. 2018

Stage 2:

We partnered with interprofessional team members to modify and tailor team-specific interventions for the three pediatric oncology teams (BMT, Solid Tumor and Neuro-Oncology).

Hill et. al. 2018 CARE Codesign Materials

Stage 3:

We assessed the feasibility of implementing the team-based interventions developed in the codesign process to: a) increase understanding of the scope of palliative care and variation in perceived timing appropriate for initiation of subspeciality consultation, b) how to manage clinical uncertainty regarding prognosis, c) best techniques for team communication and collaboration in challenging cases in which it is not clear which care options to offer patients and families, and d)best practices in discussing subspecialty palliative care consultation with families.

Stage 4:

We conducted post-intervention interviews with codesign and intervention participants to assess interprofessional team member perceptions of initiation of palliative care and subspeciality palliative care consultations.

References

Szymczak JE, Schall T, Hill DL, et al. Pediatric Oncology Providers' Perceptions of a Palliative Care Service: The Influence of Emotional Esteem and Emotional Labor. J Pain Symptom Manage. 2018.

Hill DL, Walter JK, Casas JA, DiDomenico C, Szymczak JE, Feudtner C. The codesign of an interdisciplinary team-based intervention regarding initiating palliative care in pediatric oncology. Support Care Cancer. 2018.