Characteristics and Timing of Dual Pediatric Palliative Care and Ethics Consultations.

Patients with serious illness hospitalized in the pediatric setting can receive support from Pediatric Palliative Care (PPC) and Ethics Consultation (EC). However, empirical data on dual PPC-EC involvement in pediatrics is limited. Therefore, we characterized ethical issues, contextual features, palliative care domains, and consultation timing for inpatients with dual PPC-EC involvement. We reviewed 135 EC from 2016 to 2023 at an academic children's hospital to identify cases with PPC involvement. PPC notes, demographics, and admission, consultation and discharge dates were extracted from the medical record. Ethical issues, contextual features, and palliative domains were deductively coded using established frameworks. Analyses used descriptive statistics and compared EC-first, PPC-first, and combined cases. Sixty-two inpatients had dual PPC-EC involvement: of these, 33 (53%) were infants < 1 year, 52 (84%) in the Intensive Care Unit (ICU), and 21 (34%) were discharged alive. The primary ethical issue was Beneficence/Best-Interest Concerns (14; 23%), and the most common contextual feature was Communication Dispute/Conflict (25; 40%). Most PPC consultations addressed Communication of Treatment Goals/Plans (47; 76%). PPC was consulted first in 50 patients (81%). Median EC-to-PPC interval was six days, while PPC-to-EC was fifteen days. Dual PPC-EC involvement represents a distinct patient population, primarily infants in the ICU with high mortality, facing medical and ethical challenges with communication support from both services. PPC was usually consulted first, possibly from more familiarity of PPC and PPC's role in proactive ethics. Later EC involvement indicates an area for further study for when EC is most beneficial in collaborative care.