TABLE 2.

PPCC-Based Model Summary

	PPCC-Based Model Summary
Description	Multidisciplinary CICU-based PPCCs
	Interested clinicians receive training in communication and PC principles
	Three role domains: clinical, educational, and operational
	Encourages earlier and long-standing incorporation of PC principles into the care of children with critical cardiac disease
Advantages	PPCCs have extensive expertise in both cardiac medicine and PC.
	As integral members of the CICU interdisciplinary team, PPCCs have an improved understanding of CICU culture and team dynamics to facilitate PPC integration and create a shared mindset.
	Bidirectional knowledge transfer between PPCCs and PPC subspecialists can improve symptom management and care needs of the patient population both in the CICU (by PPCCs) and to wider PPC patients (through subspecialty PPC providers).
	Improved primary PC delivery with empowered champions providing care and education;
	Specialist experts and resources can be prioritized for the most complex patients and families.
	Extends the impact and reach of PC within the CICU, providing holistic care to a greater proportion of patients and their families.
Disadvantages	Requires institutional support and buy-in from CICU providers and support for upfront and ongoing training of PPCCs
	Needs a robust institutional subspecialty PPC team to support program development and training as well as PPCC provider support and mentorship
	There are potential challenges over recruitment and retention of PPCCs and the possibility of role confusion and/or misconception
Feasibility	The PANDA PC Team: Panda Cubs
	This QI project at Children’s National involves an intensive PC educational and mentorship program for physicians, advanced practice nurses, registered nurses, and social work and child life staff, including from the CICU. The year-long program includes a 2-d course adapted from the ELNEC-PPC and EPEC-Pediatrics quarterly educational sessions, monthly rounding with discussions of case studies, and a final 1-d educational conference. Participants have mentorship and are expected to undertake a unit-based QI project to establish meaning and integrate knowledge into practice.
	PC in the Heart Center
	Department-funded training at the Boston Children’s Hospital trained 2 physicians, a cardiac intensivist and cardiologist, to complete the PCEP course with additional support to undertake rotations with the subspecialty PPC services to augment primary PC delivery in the heart center. An interdisciplinary communication and PC working group was created to better understand obstacles and implement solutions to the complex decision-making and communication surrounding the care of children with advanced heart disease, with research including parent, physician, and nursing surveys on symptom burden, prognostic awareness and communication, and a monthly journal club PC interest group.
	Mid-career PC Training Program
	This educational pilot at the Children’s Hospital of Philadelphia was funded by the Milbank Foundation. Two physicians, a cardiac intensivist, and a general pediatrician working on the complex care team participated in the program with the goal of building a PC skillset for their ongoing work within their core teams. Each attending physician spent a few weeks rotating with the consulting inpatient PC team and became trained facilitators for the VitalTalk communication skills program. Each built on their experiences to enhance primary palliative skills and awareness within their core teams and helped educate the PC team about the conditions their core teams treated.

ELNEC, End-of-Life Nursing Education Consortium; EPEC, Education in Palliative and End-of-Life Care; PCEP, Palliative Care Education and Practice.