Where We Overlap: Examining the Collaborative Practice of Neonatology and Palliative Care

BACKGROUND AND OBJECTIVES In neonates for whom prognostication is complex or uncertain, it is critical to carefully consider how best to apply principles of palliative care. As subspecialty pediatric palliative care has become more readily available within children’s hospitals, neonatologists and palliative care teams collaborate with increasing frequency. Exactly how the specialties share this work, however, is unknown. We thus set out to assess the perceptions of neonatologists and palliative care physicians on various aspects of palliative care consultation for neonatal patients. METHODS Neonatologists and palliative care clinicians at 35 academic children’s hospitals were invited to complete an anonymous online survey. Survey questions explored current practice patterns related to palliative care consultation, perceptions of consultation for specific neonatal diagnoses, and specific palliative care skills used by both neonatologists and palliative care providers. RESULTS There were 66 responses (total response rate = 66%) returned. Survey participants reported wide variation in palliative care team composition and function. Across neonatal diagnoses, respondents indicated that consultation ought to occur with increased frequency. Respondents identified specific skills as primary to neonatology, palliative care, or shared. Qualitative analysis of open-ended questions identified multiple themes that may impact the culture of collaboration between neonatology and palliative care. CONCLUSIONS Palliative care consultation for critically ill neonates continues to evolve. There is marked variation in consultation practices reported among large children’s hospitals. Neonatal and palliative care teams should work together to identify opportunities for improving collaboration, whether based on specific diagnoses or through focused educational efforts.