Psychologists in Pediatric Palliative Care: Clinical Care Models Within the United States

Objective: To examine the roles of psychologists in delivering pediatric palliative care (PPC) services, barriers and facilitators of psychologists’ involvement in PPC, and strategies to improve psychology integration into PPC. Method: N = 131 PPC professionals (45% physicians, 26% psychologists, 12% advanced practice nurses, 17% other disciplines) employed at hospitals serving pediatric patients across the United States completed an online survey. Results: Most psychologists who provide PPC services are members of a primary team that delivers palliative care independently or in collaboration with a specialized PPC program. Psychologists provide various services within the purview of PPC, including interventions to relieve children’s psychological and physical symptoms, support patient and family decision-making, and address grief and bereavement. Psychologists also commonly provide psychosocial support for health care providers and teach, supervise, and/or mentor trainees in PPC. Findings suggest a range of interrelated factors that influence integration of psychology in PPC, including funding, billing, time, training, institutional/departmental culture, quality of interdisciplinary collaborations, extent of psychosocial provider role differentiation, and perceptions of the value of psychology services. Strategies to improve integration included addressing funding, billing, and reimbursement challenges; expanding training and developing professional competencies for psychologists in PPC; optimizing communication and collaboration between psychologists and other PPC professionals; and conducting research on the value psychologists add to PPC teams. Conclusions: Pediatric psychologists provide a variety of important services to advance holistic care for children with life-limiting conditions and their families. Additional research examining the effectiveness of different models of psychology integration in PPC is warranted. Implications for Impact Statement Pediatric psychologists are not currently recognized as core members of interdisciplinary pediatric palliative care (PPC) teams, which aim to reduce physical, psychological, social, practical, and spiritual suffering for children with chronic illnesses. However, our findings suggest that pediatric psychologists provide important services to enhance the care of children with life-limiting conditions, including psychological assessment and treatment for patients and families, support for health care staff, supervision and mentorship of trainees, and skills in conducting research. This article outlines the roles and scope of services provided by psychologists within the purview of PPC and potential strategies for improving systematic inclusion of psychologists in PPC to advance holistic care for youth with serious illness and their families.