• Wynne E Morrison, France Gauvin, Emily Johnson, and Jennifer Hwang.
• Pediatric Palliative Care, The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
• Pediatr Crit Care Me. 2018 Aug 1; 19 (8S Suppl 2): S86-S91.

ObjectivesTo propose a model describing levels of integration of palliative care into the care of ICU patients.Data SourcesLiterature review and author opinion.ConclusionsAll critical care team members should demonstrate and foster their core competencies in caring for patients with complex illness and uncertain prognosis, including at the end of life. We describe these core competencies of the ICU team member as "primary" palliative care skills. Some ICU team members will have special expertise in end-of-life care or symptom management and decision-making support and will serve as local experts within the ICU team as a resource to other team members. We call this skillset "secondary" palliative care. Some patients will benefit from the full range of expertise provided by a separate consulting team, with additional training, focused on caring for patients with palliative care needs across the full spectrum of patient locations within a health system. We term the skillset provided by such outside consultants "tertiary" palliative care. Solutions for meeting patients' palliative care needs will be unique within each system and individual institution, depending on available resources, history, and structures in place. Providers from multiple professions will usually contribute to meeting patient needs.

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