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Kim CH, Lee J, Lee JW, Kim MS. The impact of specialized pediatric palliative care on advance care planning and healthcare utilization in children and young adults: a retrospective analysis of medical records of in-hospital deaths. BMC Palliat Care 2024; 23:127. [PMID: 38778335 PMCID: PMC11110344 DOI: 10.1186/s12904-024-01448-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Pediatric palliative care supports children and young adults with life-limiting conditions and their families, seeking to minimize suffering and enhance quality of life. This study evaluates the impact of specialized palliative care (SPC) on advance care planning (ACP) and patterns of end-of-life care for patients who died in the hospital. METHODS This is a retrospective cohort study of medical records extracted from a clinical data warehouse, covering patients who died aged 0-24 in an academic tertiary children's hospital in South Korea. Participants were categorized into before (2011-2013; pre-period) and after (2017-2019; post-period) the introduction of an SPC service. Within the post-period, patients were further categorized into SPC recipients and non-recipients. RESULTS We identified 274 and 205 patients in the pre-period and post-period, respectively. ACP was conducted more and earlier in the post-period than in the pre-period, and in patients who received palliative care than in those who did not. Patients who received SPC were likely to receive less mechanical ventilation or cardiopulmonary resuscitation and more opioids. A multivariable regression model showed that earlier ACP was associated with not being an infant, receiving SPC, and having a neurological or neuromuscular disease. CONCLUSIONS SPC involvement was associated with more and earlier ACP and less intense end-of-life care for children and young adults who died in the hospital. Integrating palliative care into routine care can improve the quality of end-of-life care by reflecting patients' and their families' values and preferences.
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Affiliation(s)
- Cho Hee Kim
- College of Nursing, Kangwon National University, Chuncheon, Republic of Korea
| | - Jung Lee
- Integrative Care Hub, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Ji Weon Lee
- Integrative Care Hub, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Min Sun Kim
- Integrative Care Hub, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea.
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Tafazoli A, Cronin-Wood K. Pediatric Oncology Hospice: A Comprehensive Review. Am J Hosp Palliat Care 2024:10499091241227609. [PMID: 38225192 DOI: 10.1177/10499091241227609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Pediatric hospice is a new terminology in current medical literature. Implementation of pediatric hospice care in oncology setting is a vast but subspecialized field of research and practice. However, it is accompanied by substantial uncertainties, shortages and unexplored sections. The lack of globally established definitions, principles, and guidelines in this field has adversely impacted the quality of end-of-life experiences for children with hospice needs worldwide. To address this gap, we conducted a comprehensive review of scientific literature, extracting and compiling the available but sparse data on pediatric oncology hospice from the PubMed database. Our systematic approach led to development of a well-organized structure introducing the foundational elements, highlighting complications, and uncovering hidden gaps in this critical area. This structured framework comprises nine major categories including general ideology, population specifications, role of parents and family, psychosocial issues, financial complications, service locations, involved specialties, regulations, and quality improvement. This platform can serve as a valuable resource in establishing a scientifically reliable foundation for future experiments and practices in pediatric oncology hospice.
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Affiliation(s)
- Ali Tafazoli
- Healthcare administration program, St Lawrence College, Kingston Campus, ON, Canada
- Hospice Kingston, Queen's University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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Chen SH, Wu ET, Wang CC, Su MY, Chang CH, Chen HL, Lu FL, Cheng SY. Increasing Trend and Effects of Pediatric Palliative Care on Children With Noncancer Diagnoses. J Pain Symptom Manage 2023; 66:230-237.e1. [PMID: 37290731 DOI: 10.1016/j.jpainsymman.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Pediatric palliative care (PPC), especially among noncancer pediatric patients, faces challenges including late referral, limited patient care, and insufficient data for Asian patients. METHODS This retrospective cohort study used the integrative hospital medical database between 2014 and 2018 to analyze the clinical characteristics, diagnoses, and end-of-life care for patients aged less than 20 who had died in our children's hospital, a tertiary referral medical center implementing PPC shared-care. RESULTS In our cohort of 323 children, 240 (74.3%) were noncancer patients who a younger median age at death (5 vs. 122 months, P < 0.001), lower rate of PPC involvement (16.7 vs. 66%, P < 0.001), and fewer survival days after PPC consult compared to cancer patients (3 vs. 11, P = 0.01). Patients not receiving PPC had more ventilator support (OR 9.9, P < 0.001), and less morphine use on their final day of life (OR 0.1, P < 0.001). Also, patients not receiving PPC had more cardiopulmonary resuscitation on the last day of life (OR 15.3, P < 0.001) and died in the ICU (OR 8.8, P < 0.001). There was an increasing trend of noncancer patients receiving PPC between 2014 and 2018 (P < 0.001). CONCLUSIONS High disparities exist between children receiving PPC in cancer versus noncancer patients. The concept of PPC is gradually becoming accepted in noncancer children and is associated with more pain-relief medication and less suffering during end-of-life care.
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Affiliation(s)
- Szu-Han Chen
- Department of Pediatrics (S.H.C., E.T.W., C.C.W., M.Y.S., H.L.C., F.L.L.), National Taiwan University Children's Hospital, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - En-Ting Wu
- Department of Pediatrics (S.H.C., E.T.W., C.C.W., M.Y.S., H.L.C., F.L.L.), National Taiwan University Children's Hospital, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ching-Chia Wang
- Department of Pediatrics (S.H.C., E.T.W., C.C.W., M.Y.S., H.L.C., F.L.L.), National Taiwan University Children's Hospital, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Min-Yu Su
- Department of Pediatrics (S.H.C., E.T.W., C.C.W., M.Y.S., H.L.C., F.L.L.), National Taiwan University Children's Hospital, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Pediatric Hematology and Oncology (M.Y.S.), China Medical University Children's Hospital, Taichung, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research (C.H.C.), National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Ling Chen
- Department of Pediatrics (S.H.C., E.T.W., C.C.W., M.Y.S., H.L.C., F.L.L.), National Taiwan University Children's Hospital, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department and Graduate Institute of Medical Education and Bioethics (H.L.C.), National Taiwan University College of Medicine, Taipei, Taiwan
| | - Frank Leigh Lu
- Department of Pediatrics (S.H.C., E.T.W., C.C.W., M.Y.S., H.L.C., F.L.L.), National Taiwan University Children's Hospital, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Shao-Yi Cheng
- Department of Family Medicine (S.Y.C.), National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Frenkel B, Gerasimov E, Gustafson A, Gustafson P, McLean G, Ochasi A, Waanders A, Ramaswamy V. Postmortem Tissue Donation: Giving Families the Ability to Choose. J Clin Oncol 2023; 41:447-451. [PMID: 36027484 DOI: 10.1200/jco.21.02839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Beth Frenkel
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | | | | | - Aloysius Ochasi
- Center for Clinical Bioethics, St Joseph's University, Philadelphia, PA
| | - Angela Waanders
- Division of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Feinberg School of Medicine Northwestern University, Chicago, IL
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
- Departments of Medical Biophysics and Pediatrics, University of Toronto, Toronto, ON, Canada
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Ananth P, Wolfe J, Johnston EE. Charting a path to high-quality end-of-life care for children with cancer. Cancer 2022; 128:3586-3592. [PMID: 36006762 PMCID: PMC9530011 DOI: 10.1002/cncr.34419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 11/09/2022]
Abstract
There are currently no quality measures for end-of-life (EOL) care for children with cancer. In this commentary, we address why it is essential that we develop quality measures for EOL care for children with cancer, review the progress made to date, and chart the course for future work in this area.
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Affiliation(s)
- Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
- Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, CT
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA
| | - Emily E. Johnston
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
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Cao Z, Wang Y, Zhang H. "It's a Tall Order but I'll Try": a qualitative study on Chinese nurses' cognition and experience responding to cancer patients' requests to hasten death. Support Care Cancer 2022; 30:7509-7515. [PMID: 35665858 DOI: 10.1007/s00520-022-07192-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/30/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study is to understand the cognition and experience of oncology nurses in China when responding to a patient's request to hasten death, to describe the obstacles that prevent their response, and to provide suggestions for dealing with the patient's request. METHODS Researchers conducted a qualitative study that consisted of open-ended, semi-structured interviews with 18 registered nurses who had more than 5 years of working experience in the oncology department at a large-scale urban hospital. We analyzed these data for content and themes. RESULTS How to deal with patients' requests to hasten death is a problem often encountered and handled by nurses in the Department of Oncology. Nurses have a certain understanding of the patients' requests to hasten death. This study abstracts four themes: (1) the nurses' cognition of the "Accelerate the process of death"; (2) the methods they use to deal with the patients' requests to hasten death; (3) the obstacles that prevent nurses from fulfilling the patients' requests to hasten death; and (4) their suggestions for improvement. CONCLUSION Nurses have a deep understanding of the real thoughts of patients who make a death request, and they hope to provide the corresponding psychological support and physical care. However, the lack of relevant knowledge, policy support, and cooperation of patients' families are obstacles that prevent them from taking action. Therefore, increasing relevant training for nurses, encouraging multi-department cooperation, and developing standardized nursing processes may lay a foundation for oncology nurses to better undertake and guide such conversations.
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Affiliation(s)
- Zhaoming Cao
- Department of Nursing, Nursing College of Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning, China
| | - Yingchun Wang
- Department of Oncology Department, Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Huijun Zhang
- Department of Nursing, Nursing College of Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning, China.
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Mercadante S. The need of a palliative care network. Support Care Cancer 2022; 30:6381-6383. [PMID: 35543813 DOI: 10.1007/s00520-022-07009-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/24/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center for Pain Relief and Supportive/Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy. .,Regional Home Palliative Care Program, SAMOT, Palermo, Italy.
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