I. Introduction to Hospice and Palliative Medicine

A. Definition of Palliative Care^1,2

1. 1. Palliative care is the active total care of the child’s body, mind, and spirit with the intent to prevent and relieve suffering, with a special focus on symptom control.
2. 2. Palliative medicine supports the best quality of life for the child and family. It can be provided along with disease-directed treatment from the time of diagnosis of serious illness.
3. 3. See Fig. 23.1 for the current accepted model for palliative care.

1. 1. Hospice care is an insurance benefit that may be initiated for patients who have a terminal illness with a life expectancy estimated to be 6 months or less.
2. 2. It specializes in care at the end of life to promote a child’s comfort and to support loved ones in their bereavement.

C. Concurrent Care for Children³

1. 1. Prior to the Affordable Care Act, Medicaid would only provide either curative treatment or hospice services to those who qualified.
2. 2. Now, children living with life-limiting or life-threatening conditions who are enrolled in Medicaid (and some other insurance providers) can receive both curative/life-prolonging treatments and hospice services.

D. Team Composition

1. 1. Hospice and palliative care teams are robust and interdisciplinary.
2. 2. They may include physicians, nurses, nurse practitioners, physician assistants, psychologists, counselors, social workers, child life specialists, pastoral care, patient care coordinators, and bereavement coordinators.

E. Timing of Palliative Care Consults

1. 1. Palliative care teams can become involved at any point during a child’s life, but it is best to involve them as early as possible.
2. 2. Prenatal consults may be done with parents to help them with planning, decision making, and development of a birth plan.