BACKGROUND Despite evidence that referral to pediatric palliative care reduces suffering and improves quality of life for patients and families, many clinicians delay referral until the end of life. The purpose of this article is to provide a conceptual model for why clinical teams delay discussing palliative care with parents. DISCUSSION Building on a prior model of parent regoaling and relevant research literature, we argue for a conceptual model of the challenges and facilitators a clinical team might face in shifting from a restorative-focused treatment plan to a plan that includes palliative aspects, resulting in a subspecialty palliative care referral. Like patients and families, clinicians and clinical teams may recognize that a seriously ill patient would benefit from palliative care and shift from a restorative mindset to a palliative approach. We call this transition "clinician regoaling". Clinicians may experience inhibitors and facilitators to this transition at both the individual and team level which influence the clinicians' willingness to consult subspecialty palliative care. The 8 inhibitors to team level regoaling include: 1) team challenges due to hierarchy, 2) avoidance of criticizing colleagues, 3) structural communication challenges, 4) group norms in favor of restorative goals, 5) diffusion of responsibility, 6) inhibited expression of sorrow, 7) lack of social support, 8) reinforcement of labeling and conflict. The 6 facilitators of team regoaling include: 1) processes to build a shared mental model, 2) mutual trust to encourage dissent, 3) anticipating conflict and team problem solving, 4) processes for reevaluation of goals, 5) sharing serious news as a team, 6) team flexibility. CONCLUSIONS Recognizing potential team level inhibitors to transitioning to palliative care can help clinicians develop strategies for making the transition more effectively when appropriate.

中文翻译：

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基于叙述性审查的初级临床团队请求儿科姑息治疗咨询的障碍和促进因素的概念模型。

背景 尽管有证据表明转诊儿科姑息治疗可以减少患者及其家人的痛苦并提高生活质量，但许多临床医生仍将转诊推迟到生命的尽头。本文的目的是提供一个概念模型，解释为什么临床团队延迟与父母讨论姑息治疗。讨论 基于父母重新调整的先前模型和相关研究文献，我们提出了一个临床团队在从以恢复为重点的治疗计划转向包括姑息治疗方面的计划时可能面临的挑战和促进因素的概念模型，从而导致亚专业姑息治疗转诊。与患者和家属一样，临床医生和临床团队可能会认识到，重病患者将从姑息治疗中受益，并从恢复性思维转变为姑息治疗。我们将这种转变称为“临床医生重新设定目标”。临床医生可能会在个人和团队层面经历这种转变的抑制因素和促进因素，这会影响临床医生咨询亚专业姑息治疗的意愿。团队层面目标调整的 8 种抑制因素包括：1) 等级制度带来的团队挑战；2) 避免批评同事；3) 结构性沟通挑战；4) 有利于恢复性目标的群体规范；5) 责任分散；6) 抑制表达悲伤，7）缺乏社会支持，8）标签和冲突的强化。团队重新设定目标的 6 个促进因素包括：1) 建立共享心智模型的过程，2) 鼓励异议的相互信任，3) 预期冲突和团队问题解决，4) 重新评估目标的过程，5) 将重要新闻作为团队，6）团队灵活性。结论 认识到向姑息治疗过渡的潜在团队层面阻碍因素可以帮助临床医生制定策略，在适当的时候更有效地实现过渡。