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Cuviello A, Cianchini de la Sota A, Baker J, Anghelescu D. Regional blocks for pain control at the end of life in pediatric oncology. FRONTIERS IN PAIN RESEARCH 2023; 4:1127800. [PMID: 37025167 PMCID: PMC10070999 DOI: 10.3389/fpain.2023.1127800] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Background Pain management at the end of life is a fundamental aspect of care and can improve patients' quality of life. Interventional approaches may be underutilized for pediatric cancer patients. Objective To describe a single institution's 10 years of experience with regional pain management at the end of life in pediatric oncology. Methods A retrospective cohort study of 27 patients with pediatric cancer who died between April 2011 and December 2021 and received continuous nerve block (CNB) catheters or single-shot nerve blocks (SSBs) during their last three months of life. The type of blocks, analgesic efficacy, and palliative care involvement were evaluated. Results Twenty-two patients (81.5%) had solid tumor diagnoses, including carcinomas, sarcomas, and neuroblastoma. Most (59%) patients received CNB catheters, and 12 patients (44%) received SSBs for pain control. The mean pain score decreases for CNB catheters and SSBs after interventions were -2.5 and -2.8, respectively, on an 11-point scale. Decreases in opioid patient-controlled analgesia dosing requirements were noted in 56% of patients with CNB catheters; likewise, in 25% of patients with SSBs at 24 h and in 8% at 5 days after interventions. Nearly all patients had PC involvement and received care from pain specialists (96% and 93%, respectively). Twenty-three (85%) had physician orders for scope of treatment orders completed before death. Conclusion Regional pain control interventions can be effective and safe for relieving regional pain and suffering in dying children and young adults. The collaboration between palliative care and pain management specialists at the end of life can help alleviate suffering and improve quality of life.
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Affiliation(s)
- Andrea Cuviello
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | | | - Justin Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Doralina Anghelescu
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
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2
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Cuviello A, Pasli M, Bhatia S, Johnson LM, Anghelescu DL, Baker JN. Dexmedetomidine and Propofol at End of Life in Pediatric Oncology: Trends in Palliative Sedation Therapy. J Palliat Med 2023; 26:79-86. [PMID: 35944277 PMCID: PMC9810498 DOI: 10.1089/jpm.2021.0650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 01/13/2023] Open
Abstract
Context: Palliative sedation therapy (PST) can address suffering at the end of life (EOL) in children with cancer; yet, little is known about PST in this population. Objectives: We sought to describe the characteristics of pediatric oncology patients requiring PST at the EOL. Methods: A retrospective review was completed for pediatric oncology patients who required PST at a United States academic institution over 10 years, including demographics, disease characteristics, EOL characteristics, and medications for PST and symptom management. Results: PST was utilized in 3% of patients at the EOL. Of 24 study participants receiving PST, 83% (n = 20), 12.5% (n = 3), and 4.2% (n = 1) received dexmedetomidine, propofol, or both, respectively. The most frequent diagnosis for patients receiving PST was acute myelogenous leukemia (20.8%, n = 5). All patients were followed up by the palliative care team, and two-thirds (66.6%, n = 16) were also followed up by the pain management service; 79% (n = 19) were enrolled in hospice, and 98.5% (n = 23) had a Physician Orders for Scope of Treatment in place. Pain was the most common refractory symptom leading to PST initiation (33.3%, n = 8), followed by neuroagitation and dyspnea. PST was initiated a median of 2.5 days before death. A third of deaths occurred in the intensive care unit (33.3%, n = 8). Conclusions: PST was rare in this study; dexmedetomidine was used as first-line treatment for PST in patients at the EOL with refractory symptoms. Its place in PST protocols in pediatric oncology should be validated with prospective studies. Our study suggests the potential value of collaboration between palliative care and pain specialists in the context of PST.
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Affiliation(s)
- Andrea Cuviello
- Division of Oncology and Anesthesiology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Melisa Pasli
- Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Shalini Bhatia
- Division of Oncology and Anesthesiology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Liza-Marie Johnson
- Division of Oncology and Anesthesiology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Doralina L. Anghelescu
- Division of Oncology and Anesthesiology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Justin N. Baker
- Division of Oncology and Anesthesiology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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3
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Vemuri S, Butler AE, Brown K, Wray J, Bluebond-Langner M. Palliative care for children with complex cardiac conditions: survey results. Arch Dis Child 2022; 107:282-287. [PMID: 34312164 PMCID: PMC8862095 DOI: 10.1136/archdischild-2020-320866] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 07/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore perspectives of paediatric cardiac and palliative care professionals on providing palliative care to children with complex cardiac conditions. DESIGN A national survey including closed-ended and open-ended questions as well as clinical scenarios designed to capture referral practices, attitudes towards palliative care, confidence delivering key components of palliative care and perspectives on for whom to provide palliative care. Responses to closed-ended questions and scenarios were analysed using descriptive statistics. Open-ended responses were analysed thematically. PARTICIPANTS Paediatric cardiac and palliative care professionals caring for children with complex cardiac conditions in the UK. RESULTS 177 professionals (91 cardiac care and 86 palliative care) responded. Aspects of advance care planning were the most common reasons for referral to palliative care. Palliative care professionals reported greater confidence than cardiac colleagues with such discussions. Clinicians agreed that children with no further surgical management options, comorbid genetic disorders, antenatal diagnosis of a single ventricle, ventricular device in situ, symptomatic heart failure and those awaiting heart transplantation would benefit from palliative care involvement. CONCLUSIONS Components of palliative care, such as advance care planning, can be provided by cardiac care professionals alongside the disease-directed care of children with complex cardiac conditions. Further research and training are needed to address confidence levels in cardiac care professionals in delivering components of palliative care as well as clarification of professional roles and parent preferences in delivery of family-centred care for children with complex cardiac conditions.
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Affiliation(s)
- Sidharth Vemuri
- Victorian Paediatric Palliative Care Program, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia,Louis Dundas Centre for Children's Palliative Care, University College London Great Ormond Street Institute for Child Health, London, UK
| | - Ashleigh E Butler
- Louis Dundas Centre for Children's Palliative Care, University College London Great Ormond Street Institute for Child Health, London, UK,Austin Health Clinical School, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Katherine Brown
- Institute of Cardiovascular Science, University College London, London, UK,Heart Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jo Wray
- Institute of Cardiovascular Science, University College London, London, UK,Heart Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK,Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children's Palliative Care, University College London Great Ormond Street Institute for Child Health, London, UK .,Rutgers University, Camden, New Jersey, USA
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4
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Kaye EC, Weaver MS, DeWitt LH, Byers E, Stevens SE, Lukowski J, Shih B, Zalud K, Applegarth J, Wong HN, Baker JN, Ullrich CK. The Impact of Specialty Palliative Care in Pediatric Oncology: A Systematic Review. J Pain Symptom Manage 2021; 61:1060-1079.e2. [PMID: 33348034 PMCID: PMC9896574 DOI: 10.1016/j.jpainsymman.2020.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Children with cancer and their families have complex needs related to symptoms, decision-making, care planning, and psychosocial impact extending across the illness trajectory, which for some includes end of life. Whether specialty pediatric palliative care (SPPC) is associated with improved outcomes for children with cancer and their families is unknown. OBJECTIVE We conducted a systematic review following PRISMA guidelines to investigate outcomes associated with SPPC in pediatric oncology with a focus on intervention delivery, collaboration, and alignment with National Quality Forum domains. METHODS We searched PubMed, Embase, Scopus, Web of Science, and CINAHL databases from inception until April 2020 and reviewed references manually. Eligible articles were published in English, involved pediatric patients aged 0-18 years with cancer, and contained original data regarding patient and family illness and end-of-life experiences, including symptom management, communication, decision-making, quality of life, satisfaction, and healthcare utilization. RESULTS We screened 6682 article abstracts and 82 full-text articles; 32 studies met inclusion criteria, representing 15,635 unique children with cancer and 342 parents. Generally, children with cancer who received SPPC had improved symptom burden, pain control, and quality of life with decreased intensive procedures, increased completion of advance care planning and resuscitation status documentation, and fewer end-of-life intensive care stays with higher likelihood of dying at home. Family impact included satisfaction with SPPC and perception of improved communication. CONCLUSION SPPC may improve illness experiences for children with cancer and their families. Multisite studies utilizing comparative effectiveness approaches and validated metrics may support further advancement of the field.
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Affiliation(s)
- Erica C Kaye
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
| | - Meaghann S Weaver
- Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Leila Hamzi DeWitt
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Elizabeth Byers
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sarah E Stevens
- Departments of Psychosocial Oncology and Palliative Care and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joe Lukowski
- The University of Nebraska, Omaha, Nebraska, USA
| | - Brandon Shih
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kristina Zalud
- St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jacob Applegarth
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hong-Nei Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, California, USA
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Christina K Ullrich
- Departments of Psychosocial Oncology and Palliative Care and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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5
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Kaye EC, Gushue CA, DeMarsh S, Jerkins J, Sykes A, Lu Z, Snaman JM, Blazin L, Johnson LM, Levine DR, Morrison RR, Baker JN. Illness and end-of-life experiences of children with cancer who receive palliative care. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26895. [PMID: 29218773 PMCID: PMC6159948 DOI: 10.1002/pbc.26895] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/19/2017] [Accepted: 10/24/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The field of pediatric palliative oncology is newly emerging. Little is known about the characteristics and illness experiences of children with cancer who receive palliative care (PC). METHODS A retrospective cohort study of 321 pediatric oncology patients enrolled in PC who died between 2011 and 2015 was conducted at a large academic pediatric cancer center using a comprehensive standardized data extraction tool. RESULTS The majority of pediatric palliative oncology patients received experimental therapy (79.4%), with 40.5% enrolled on a phase I trial. Approximately one-third received cancer-directed therapy during the last month of life (35.5%). More than half had at least one intensive care unit hospitalization (51.4%), with this subset demonstrating considerable exposure to mechanical ventilation (44.8%), invasive procedures (20%), and cardiopulmonary resuscitation (12.1%). Of the 122 patients who died in the hospital, 44.3% died in the intensive care unit. Patients with late PC involvement occurring less than 30 days before death had higher odds of dying in the intensive care unit over the home/hospice setting compared to those with earlier PC involvement (OR: 4.7, 95% CI: 2.47-8.97, P < 0.0001). CONCLUSIONS Children with cancer who receive PC experience a high burden of intensive treatments and often die in inpatient intensive care settings. Delayed PC involvement is associated with increased odds of dying in the intensive care unit. Prospective investigation of early PC involvement in children with high-risk cancer is needed to better understand potential impacts on cost-effectiveness, quality of life, and delivery of goal concordant care.
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Affiliation(s)
| | - Courtney A. Gushue
- Le Bonheur Children’s Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - Samantha DeMarsh
- Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
| | - Jonathan Jerkins
- Le Bonheur Children’s Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - April Sykes
- St. Jude Children’s Research Hospital, Memphis, TN
| | - Zhaohua Lu
- St. Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer M. Snaman
- Dana-Farber Cancer Institute, Boston, MA
- Boston Children’s Hospital, Boston, MA
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6
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Brock KE, Wolfe J, Ullrich C. From the Child's Word to Clinical Intervention: Novel, New, and Innovative Approaches to Symptoms in Pediatric Palliative Care. CHILDREN (BASEL, SWITZERLAND) 2018; 5:E45. [PMID: 29597333 PMCID: PMC5920391 DOI: 10.3390/children5040045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/12/2018] [Accepted: 03/21/2018] [Indexed: 12/13/2022]
Abstract
Despite vast improvements in disease-based treatments, many children live with life-threatening disorders that cause distressing symptoms. These symptoms can be difficult to comprehensively assess and manage. Yet, frequent and accurate symptom reporting and expert treatment is critical to preserving a patient's physical, psychological, emotional, social, and existential heath. We describe emerging methods of symptom and health-related quality-of-life (HRQOL) assessment through patient-reported outcomes (PROs) tools now used in clinical practice and novel research studies. Computer-based and mobile apps can facilitate assessment of symptoms and HRQOL. These technologies can be used alone or combined with therapeutic strategies to improve symptoms and coping skills. We review technological advancements, including mobile apps and toys, that allow improved symptom reporting and management. Lastly, we explore the value of a pediatric palliative care interdisciplinary team and their role in assessing and managing distressing symptoms and minimizing suffering in both the child and family. These methods and tools highlight the way that novel, new, and innovative approaches to symptom assessment and management are changing the way that pediatrics and pediatric palliative care will be practiced in the future.
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Affiliation(s)
- Katharine E Brock
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA 30322, USA.
- Pediatric Palliative Care, Children's Healthcare of Atlanta, Atlanta, GA 30322, USA.
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, GA 30322, USA.
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
- Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute, Boston Children's Hospital Cancer and Blood Disorders Center, Boston, MA 02215, USA.
| | - Christina Ullrich
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
- Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute, Boston Children's Hospital Cancer and Blood Disorders Center, Boston, MA 02215, USA.
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7
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Keim MC, Lehmann V, Shultz EL, Winning AM, Rausch JR, Barrera M, Gilmer MJ, Murphy LK, Vannatta KA, Compas BE, Gerhardt CA. Parent-Child Communication and Adjustment Among Children With Advanced and Non-Advanced Cancer in the First Year Following Diagnosis or Relapse. J Pediatr Psychol 2017; 42:871-881. [PMID: 28369400 DOI: 10.1093/jpepsy/jsx058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/09/2017] [Indexed: 11/12/2022] Open
Abstract
Objectives To examine parent-child communication (i.e., openness, problems) and child adjustment among youth with advanced or non-advanced cancer and comparison children. Methods Families (n = 125) were recruited after a child's diagnosis/relapse and stratified by advanced (n = 55) or non-advanced (n = 70) disease. Comparison children (n = 60) were recruited from local schools. Children (ages 10-17) reported on communication (Parent-Adolescent Communication Scale) with both parents, while mothers reported on child adjustment (Child Behavior Checklist) at enrollment (T1) and one year (T2). Results Openness/problems in communication did not differ across groups at T1, but problems with fathers were higher among children with non-advanced cancer versus comparisons at T2. Openness declined for all fathers, while changes in problems varied by group for both parents. T1 communication predicted later adjustment only for children with advanced cancer. Conclusions Communication plays an important role, particularly for children with advanced cancer. Additional research with families affected by life-limiting conditions is needed.
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Affiliation(s)
- Madelaine C Keim
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health.,The Ohio State University, Department of Pediatrics
| | - Vicky Lehmann
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health.,The Ohio State University, Department of Pediatrics
| | - Emily L Shultz
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health.,The Ohio State University, Department of Pediatrics
| | - Adrien M Winning
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health.,The Ohio State University, Department of Pediatrics
| | - Joseph R Rausch
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health.,The Ohio State University, Department of Pediatrics
| | - Maru Barrera
- Hospital for Sick Children, Child Health Evaluative Sciences
| | - Mary Jo Gilmer
- Vanderbilt University, Department of Psychology and Human Development
| | - Lexa K Murphy
- Vanderbilt University, Department of Psychology and Human Development
| | - Kathryn A Vannatta
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health.,The Ohio State University, Department of Pediatrics
| | - Bruce E Compas
- Vanderbilt University, Department of Psychology and Human Development
| | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health.,The Ohio State University, Department of Pediatrics
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8
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End-of-life care in children with hematologic malignancies. Oncotarget 2017; 8:89939-89948. [PMID: 29163800 PMCID: PMC5685721 DOI: 10.18632/oncotarget.21188] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/17/2017] [Indexed: 12/13/2022] Open
Abstract
Introduction Hematologic malignancies (HM) represent the most common neoplasms in childhood. Despite improved overall survival rates, they are still a major contributor to cancer death in children. Aims To determine the proportion of children with HM in pediatric palliative care (PPC) and to identify the clinical characteristics and symptoms in comparison to children with extracranial solid tumors (non HM patients). Patients and Methods This study was conducted as a single-center retrospective cohort study of patients in the care of a large specialized PPC team. Results Fifteen HM and 50 non HM patients were included. Symptoms in which HM patients scored significantly higher than non HM patients were mucositis, difficulty moving, somnolence, fatigue, petechiae and paleness. Blood transfusions were more frequently administered to HM patients, but large external hemorrhage was not observed in any child. A large variety of drugs and appliances were needed by the patients, with morphine being the most frequently prescribed drug. During the study period, a much larger and over the years even increasing number of HM patients (not in the care of the PPC team) died in hospital with an (assumed) curative intent, with two thirds dying in the ICU. Conclusions Children with HM were referred to outpatient PPC with almost the full clinical picture of advanced leukemia. Noteworthy, the number of children with HM dying at home is decreasing in our center, instead a substantial proportion received high-intensity medical hospital care including novel anticancer therapies. These patients thus seem to be at an increased risk of dying in hospital as the right time to transfer them to palliative care is oftentimes missed.
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9
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Kaye EC, Snaman JM, Baker JN. Pediatric Palliative Oncology: Bridging Silos of Care Through an Embedded Model. J Clin Oncol 2017; 35:2740-2744. [DOI: 10.1200/jco.2017.73.1356] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Erica C. Kaye
- Erica C. Kaye, Jennifer M. Snaman, and Justin N. Baker, St Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer M. Snaman
- Erica C. Kaye, Jennifer M. Snaman, and Justin N. Baker, St Jude Children’s Research Hospital, Memphis, TN
| | - Justin N. Baker
- Erica C. Kaye, Jennifer M. Snaman, and Justin N. Baker, St Jude Children’s Research Hospital, Memphis, TN
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10
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Brand S, Wolfe J, Samsel C. The Impact of Cancer and its Treatment on the Growth and Development of the Pediatric Patient. Curr Pediatr Rev 2017; 13:24-33. [PMID: 27848890 PMCID: PMC5503788 DOI: 10.2174/1573396313666161116094916] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/08/2016] [Accepted: 12/12/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cancer treatment can have profound effects on the growth and development of pediatric patients. Different models of psychosocial development and behavioral treatment approaches aid children receiving medical treatment. Providing education, anticipatory guidance, and individualized support to child and their families is a psychosocial standard. OBJECTIVE Clarify the different models of psychosocial development and applicable psychosocial interventions to better prepare and tailor cancer treatment to pediatric patients. METHODS Authors reviewed existing evidenced-based literature in oncology, psychology, developmental, and psychiatric while drawing on case examples and expert knowledge to illustrate the impact of cancer treatment on pediatric patients, analyze developmentally individualized needs, and describe facilitative interventions. RESULT Pediatric patients of all ages cope and adjust better to all phases of treatment when their care is delivered in a developmentally-informed and psychosocially thoughtful way. CONCLUSION Providers can comprehensively prepare their patients and families for treatment better by utilizing a psychosocially- and developmentally-informed framework while meeting individualized unique needs of patients. An integrated multidisciplinary psychosocial support team is facilitative in anticipating and meeting the needs of pediatric cancer patients and has recently become a psychosocial standard of care.
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Affiliation(s)
- Sarah Brand
- Dana-Farber Cancer Institute, 450 Brookline Avenue, SW360E, Boston, MA 02115. United States
| | - Joanne Wolfe
- Department of Medicine, Boston Children`s Hospital, MA. United States
| | - Chase Samsel
- Harvard Medical School, Boston, MA. United States
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11
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Weaver MS, Heinze KE, Kelly KP, Wiener L, Casey RL, Bell CJ, Wolfe J, Garee AM, Watson A, Hinds PS. Palliative Care as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer 2016; 62 Suppl 5:S829-33. [PMID: 26700928 DOI: 10.1002/pbc.25695] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/14/2015] [Indexed: 11/08/2022]
Abstract
The study team conducted a systematic review of pediatric and adolescent palliative cancer care literature from 1995 to 2015 using four databases to inform development of a palliative care psychosocial standard. A total of 209 papers were reviewed with inclusion of 73 papers for final synthesis. Revealed topics of urgent consideration include the following: symptom assessment and intervention, direct patient report, effective communication, and shared decision-making. Standardization of palliative care assessments and interventions in pediatric oncology has the potential to foster improved quality of care across the cancer trajectory for children and adolescents with cancer and their family members.
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Affiliation(s)
- Meaghann S Weaver
- Department of Oncology, Children's National Health System, Washington, DC.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Katherine P Kelly
- Department of Nursing Research and Quality Outcomes, Children's National Health System, Washington, DC
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Robert L Casey
- Center for Cancer & Blood Disorders, Children's Hospital Colorado, University of Colorado, Denver, Colorado
| | - Cynthia J Bell
- College of Nursing, Wayne State University, Detroit, Michigan.,Hospice of Michigan Institute, Detroit, Michigan
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Amy M Garee
- Department of Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Anne Watson
- Department of Critical Care Medicine, Children's National Health System, Washington, DC
| | - Pamela S Hinds
- Department of Nursing Research and Quality Outcomes, Children's National Health System, Washington, DC.,Department of Pediatrics, George Washington University, Washington, DC
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12
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Kaye EC, Friebert S, Baker JN. Early Integration of Palliative Care for Children with High-Risk Cancer and Their Families. Pediatr Blood Cancer 2016; 63:593-7. [PMID: 26579997 DOI: 10.1002/pbc.25848] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 10/15/2015] [Indexed: 12/25/2022]
Abstract
Despite increasing data to support pediatric palliative care (PPC) as an integral component of high-quality care for children with life-threatening conditions and their families, timely integration of PPC is offered inconsistently to children with high-risk cancer. In this review, we summarize the growing body of literature in support of early integration of PPC for children with high-risk cancer and their families, advocating that PPC principles and resources are imperative to holistic cancer-directed care and rooted in evidence-based medicine. Finally, we offer possible strategies for optimizing integration of PPC into holistic cancer care for children and families.
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Affiliation(s)
- Erica C Kaye
- Departments of Oncology and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Justin N Baker
- Departments of Oncology and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee
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13
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Weaver MS, Heinze KE, Bell CJ, Wiener L, Garee AM, Kelly KP, Casey RL, Watson A, Hinds PS. Establishing psychosocial palliative care standards for children and adolescents with cancer and their families: An integrative review. Palliat Med 2016; 30:212-23. [PMID: 25921709 PMCID: PMC4624613 DOI: 10.1177/0269216315583446] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite standardization in disease assessments and curative interventions for childhood cancer, palliative assessments and psychosocial interventions remain diverse and disparate. AIM Identify current approaches to palliative care in the pediatric oncology setting to inform development of comprehensive psychosocial palliative care standards for pediatric and adolescent patients with cancer and their families. Analyze barriers to implementation and enabling factors. DESIGN Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines framed the search strategy and reporting. Data analysis followed integrative review methodology. DATA SOURCES Four databases were searched in May 2014 with date restrictions from 2000 to 2014: PubMed, Cochrane, PsycINFO, and Scopus. A total of 182 studies were included for synthesis. Types of studies included randomized and non-randomized trials with or without comparison groups, qualitative research, prior reviews, expert opinion, and consensus report. RESULTS Integration of patient, parent, and clinician perspectives on end-of-life needs as gathered from primary manuscripts (using NVivo coding for first-order constructs) revealed mutual themes across stakeholders: holding to hope, communicating honestly, striving for relief from symptom burden, and caring for one another. Integration of themes from primary author palliative care outcome reports (second-order constructs) revealed the following shared priorities in cancer settings: care access; cost analysis; social support to include primary caregiver support, sibling care, bereavement outreach; symptom assessment and interventions to include both physical and psychological symptoms; communication approaches to include decision-making; and overall care quality. CONCLUSION The study team coordinated landmark psychosocial palliative care papers into an informed conceptual model (third-order construct) for approaching pediatric palliative care and psychosocial support in oncology settings.
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Affiliation(s)
- Meaghann S Weaver
- Department of Oncology, Children's National Health System, Washington, DC, USA Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Cynthia J Bell
- College of Nursing, Wayne State University, Detroit, MI, USA Hospice of Michigan Institute, Detroit, MI, USA
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amy M Garee
- Department of Oncology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Katherine P Kelly
- Department of Nursing Research and Quality Outcomes, Children's National Health System, Washington, DC, USA
| | - Robert L Casey
- Department of Psychology, University of Colorado, Denver, CO, USA
| | - Anne Watson
- Department of Critical Care Medicine, Children's National Health System, Washington DC, USA
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14
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Veldhuijzen van Zanten SEM, van Meerwijk CLLI, Jansen MHA, Twisk JWR, Anderson AK, Coombes L, Breen M, Hargrave OJ, Hemsley J, Craig F, Cruz O, Kaspers GJL, van Vuurden DG, Hargrave DR. Palliative and end-of-life care for children with diffuse intrinsic pontine glioma: results from a London cohort study and international survey. Neuro Oncol 2015; 18:582-8. [PMID: 26459800 DOI: 10.1093/neuonc/nov250] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 09/04/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND More than 90% of patients with diffuse intrinsic pontine glioma (DIPG) will die within 2 years of diagnosis. Patients deteriorate rapidly during the disease course, which severely impairs their quality of life. To date, no specific research on this clinically important subject has been conducted. This study aimed to compile an inventory of symptoms experienced, interventions applied, and current service provision in end-of-life care for DIPG. METHODS We performed a retrospective cohort study of children with DIPG, aged 0-18 years, who received treatment under the care of 2 London hospitals. Symptoms, interventions, and services applied during the 12 weeks before death were analyzed. In addition, we conducted a global questionnaire-study among health care professionals. RESULTS In more than 78% of DIPG patients, problems concerning mobility, swallowing, communication, consciousness, and breathing arose during end-stage disease. Supportive drugs were widely prescribed. The use of medical aids was only documented in <15% of patients. Palliative and end-of-life care was mostly based on the health care professional's experience; only 21% of the questionnaire respondents reported to have a disease-specific palliative care guideline available. CONCLUSIONS This research assessed the current state of palliative and end-of-life care for children with DIPG. Our results show the variability and complexity of symptoms at end-stage disease and the current lack of disease-specific guidelines for this vulnerable group of patients. This first descriptive paper is intended to act as a solid basis for developing an international clinical trial and subsequent guideline to support high-quality palliative and end-of-life care.
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Affiliation(s)
- Sophie E M Veldhuijzen van Zanten
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Charlotte L L I van Meerwijk
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Marc H A Jansen
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Jos W R Twisk
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Anna-Karenia Anderson
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Lucy Coombes
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Maggie Breen
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Olivia J Hargrave
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - June Hemsley
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Finella Craig
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Ofelia Cruz
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Gertjan J L Kaspers
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Dannis G van Vuurden
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Darren R Hargrave
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
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15
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Vern-Gross TZ, Lam CG, Graff Z, Singhal S, Levine DR, Gibson D, Sykes A, Anghelescu DL, Yuan Y, Baker JN. Patterns of End-of-Life Care in Children With Advanced Solid Tumor Malignancies Enrolled on a Palliative Care Service. J Pain Symptom Manage 2015; 50:305-12. [PMID: 25891664 PMCID: PMC4550524 DOI: 10.1016/j.jpainsymman.2015.03.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 03/24/2015] [Accepted: 04/01/2015] [Indexed: 11/24/2022]
Abstract
CONTEXT Pediatric patients with solid tumors can have a significant symptom burden that impacts quality of life (QoL) and end-of-life care needs. OBJECTIVES We evaluated outcomes and symptoms in children with solid tumors and compared patterns of end-of-life care after implementation of a dedicated institutional pediatric palliative care (PC) service. METHODS We performed a retrospective cohort study of children with solid tumors treated at St. Jude Children's Research Hospital, before and after implementation of the institutional QoL/PC service in January 2007. Patients who died between July 2001 and February 2005 (historical cohort; n = 134) were compared with those who died between January 2007 and January 2012 (QoL/PC cohort; n = 57). RESULTS Median time to first QoL/PC consultation was 17.2 months (range 9-33). At consultation, 60% of children were not receiving or discontinued cancer-directed therapy. Within the QoL/PC cohort, 54 patients had documented symptoms, 94% required intervention for ≥3 symptoms, and 76% received intervention for ≥5 symptoms. Eighty-three percent achieved their preferred place of death. Compared with the historical cohort, the QoL/PC cohort had more end-of-life discussions per patient (median 12 vs. 3; P < 0.001), earlier end-of-life discussions, with longer times before do-not-resuscitate orders (median 195 vs. 2 days; P < 0.001), and greater hospice enrollment (71% vs. 46%, P = 0.002). CONCLUSION Although children with solid tumor malignancies may have significant symptom burden toward the end of life, positive changes were documented in communication and in places of care and death after implementation of a pediatric PC service.
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Affiliation(s)
- Tamara Z Vern-Gross
- Department of Radiation Oncology, University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
| | - Catherine G Lam
- Division of Solid Tumors, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Zachary Graff
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Sara Singhal
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Deena R Levine
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Deborah Gibson
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - April Sykes
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Doralina L Anghelescu
- Division of Anesthesiology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ying Yuan
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
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16
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Listening to parents: The role of symptom perception in pediatric palliative home care. Palliat Support Care 2015; 14:13-9. [DOI: 10.1017/s1478951515000462] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:This study analyzes symptom perception by parents and healthcare professionals and the quality of symptom management in a pediatric palliative home care setting and identifies which factors contribute to a high quality of palliative and end-of-life care for children.Methods:In this retrospective, cross-sectional study, parents were surveyed at the earliest three months after their child's death. All children were cared for by a specialized home pediatric palliative care team that provides a 24/7 medical on-call service. Questionnaires assessed symptom prevalence and intensity during the child's last month of life as perceived by parents, symptom perception, and treatment by medical staff. The responses were correlated with essential palliative care outcome measures (e.g., satisfaction with the care provided, quality-of-life of affected children and parents, and peacefulness of the dying phase).Results:Thirty-eight parent dyads participated (return rate 84%; 35% oncological disorders). According to parental report, dyspnea (61%) and pain (58%) were the dominant symptoms with an overall high symptom load (83%). Pain, agitation, and seizures could be treated more successfully than other symptoms. Successful symptom perception was achieved in most cases and predicted the quality of symptom treatment (R2, 0.612). Concordant assessment of symptom severity between parents and healthcare professionals (HCPs) improved the satisfaction with the care provided (p = 0.037) as well as the parental quality-of-life (p = 0.041). Even in cases with unsuccessful symptom control, parents were very satisfied with the SHPPC team's care (median 10; numeric rating scale 0–10) and rated the child's death as highly peaceful (median 9).Significance of the results:The quality and the concordance of symptom perception between parents and HCPs essentially influence parental quality-of-life as well as parental satisfaction and constitute a predictive factor for the quality of symptom treatment and palliative care.
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Howes C. Caring until the end: a systematic literature review exploring Paediatric Intensive Care Unit end-of-life care. Nurs Crit Care 2014; 20:41-51. [PMID: 25378129 DOI: 10.1111/nicc.12123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/23/2014] [Accepted: 07/07/2014] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES A systematic review of the literature focusing on the provision of end-of-life care (EOLC) on Paediatric Intensive Care Units (PICUs) and the options available to children and families within contemporary clinical practice. BACKGROUND The death of a child is recognized as a uniquely traumatic experience for a parent. The care delivered to a child and family surrounding death can have a lasting effect on the grieving process. The majority of paediatric deaths occur within PICUs, often as a result of withdrawing or withholding treatment. Withdrawal of intensive care is becoming more common within UK PICUs, and this review will focus on the options available when a child's on-going treatment is deemed to be futile. SEARCH STRATEGIES Literature published from 2002 to 2013 was obtained from a range of sources and critically reviewed. Cormack's (2000) framework for systematic literature review was utilized to critically review literature before analysis and synthesis of the literature was undertaken within the qualitative approach. INCLUSION/EXCLUSION CRITERIA Each article focused on issues surrounding the topic area, excluded adult and neonatal intensive care and was published in English. CONCLUSIONS Eight papers met the inclusion criteria and were suitable for review (highlighting difficulties in reviewing a small, complex subject area). Key themes identified included family views, staff views, decision-making, medico-legal issues and resources. RELEVANCE TO CLINICAL PRACTICE Although the number of relevant articles is limited, a wide range of challenges facing children, parents and staff are highlighted, whilst generally supporting the facilitation of transferring children to their homes or hospice for withdrawal of intensive care and continuing EOLC. Further research is required, particularly regarding long-term implications, legal issues and the effectiveness of clinical protocols.
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Affiliation(s)
- Catherine Howes
- Nursing Studies (Child Branch), MSc Advancing Professional Practice (Paediatrics), Senior Staff Nurse, CICU, Great Ormond Street Hospital for Children, NHS Foundation Trust, London WC1N 3JH, UK
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Yoshida S, Amano K, Ohta H, Kusuki S, Morita T, Ogata A, Hirai K. A comprehensive study of the distressing experiences and support needs of parents of children with intractable cancer. Jpn J Clin Oncol 2014; 44:1181-8. [PMID: 25249378 DOI: 10.1093/jjco/hyu140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The primary endpoints of this study were: (1) to explore the distressing experiences of parents of patients with intractable pediatric cancer in Japan from disclosure of poor prognosis to the present and (2) to explore support they regarded as necessary. METHODS A multi-center questionnaire survey was conducted that included 135 bereaved parents of patients with pediatric cancer in Japan. RESULTS The top five distressing experiences shared by over half of the bereaved parents were: 'Realize that the child's disease was getting worse' (96.7%), 'Witness the child's suffering' (96.7%), 'Make many decisions on the basis that the child will die in the not-so-distant future' (83.6%), 'Feel anxious and nervous about the child's acute deterioration' (82.0%) and 'Realize that there was nothing that I could do for the child' (78.7%). The top five support regarded as necessary were: 'Visit the room and speak to the sick child every day' (90.2%), 'Provide up-to-date information' (80.3%), 'Sufficiently explain the disadvantages of each treatment option' (80.3%), 'Show a never-give-up attitude until the end' (78.7%) and 'Make arrangements to allow the sick child to spend time with his/her siblings' (73.8%). CONCLUSIONS This study identified the common distressing experiences of parents and the support regarded as necessary by them. To provide efficient support with limited manpower in pediatric setting, healthcare professionals should recognize these tasks as high priorities when engage parents of intractable pediatric cancer patients.
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Affiliation(s)
- Saran Yoshida
- Center for Cancer Control and Information Services, National Cancer Center, Chuo-ku, Tokyo
| | - Koji Amano
- Department of Clinical Laboratory, Seirei Mikatahara General Hospital, Hamamatsu City, Shizuoka
| | - Hideaki Ohta
- Department of Pediatrics, Higashitoyonaka Watanabe Hospital, Toyonaka City, Osaka
| | | | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu City, Shizuoka
| | - Akiko Ogata
- Graduate School of Education, Hiroshima University, Higashi-Hiroshima City, Hiroshima
| | - Kei Hirai
- Support Office for Large-Scale Education and Research Projects, Osaka University, Suita City, Osaka, Japan
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Arland LC, Hendricks-Ferguson VL, Pearson J, Foreman NK, Madden JR. Development of an in-home standardized end-of-life treatment program for pediatric patients dying of brain tumors. J SPEC PEDIATR NURS 2013; 18:144-57. [PMID: 23560586 DOI: 10.1111/jspn.12024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 11/12/2012] [Accepted: 01/10/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate an end-of-life (EOL) program related to specific outcomes (i.e., number of hospitalizations and place of death) for children with brain tumors. DESIGN AND METHODS From 1990 to 2005, a retrospective chart review was performed related to specified outcomes for 166 children with admission for pediatric brain tumors. RESULTS Patients who received the EOL program were hospitalized less often (n = 114; chi-square = 5.001 with df = 1, p <.05) than patients who did not receive the program. PRACTICE IMPLICATIONS An EOL program may improve symptom management and decrease required hospital admissions for children with brain tumors.
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Affiliation(s)
- Lesley C Arland
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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Abstract
Pediatric palliative care at the end-of-life is focused on ensuring the best possible quality of life for patients with life-threatening illness and their families. To achieve this goal, important needs include: engaging with patients and families; improving communication and relationships; relieving pain and other symptoms, whether physical, psychosocial, or spiritual; establishing continuity and consistency of care across different settings; considering patients and families in the decision-making process about services and treatment choices to the fullest possible and desired degree; being sensitive to culturally diverse beliefs and values about death and dying; and responding to suffering, bereavement, and providing staff support. Any effort to improve quality of palliative and end-of-life care in pediatric oncology must be accompanied by an educational strategy to enhance the level of competence among health care professionals with regard to palliative care and end-of-life management skills as well as understanding of individualized care planning and coordination processes.
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Vern-Gross T. Establishing communication within the field of pediatric oncology: a palliative care approach. Curr Probl Cancer 2012; 35:337-50. [PMID: 22136707 DOI: 10.1016/j.currproblcancer.2011.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kars MC, Grypdonck MHF, Beishuizen A, Meijer-van den Bergh EMM, van Delden JJM. Factors influencing parental readiness to let their child with cancer die. Pediatr Blood Cancer 2010; 54:1000-8. [PMID: 20405517 DOI: 10.1002/pbc.22532] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND One in four cases of childhood cancer is incurable. In these cases death can usually be anticipated and therefore preceded by a phase of palliative care. For parents, preparing to let their child die is an extraordinarily painful process. Most struggle to preserve their child. This study identified, from a parental perspective, the main factors that influence the transition from preserving life to letting go. PROCEDURE A multi-centre, qualitative research, study was undertaken during the end-of-life (EoL) phase, comprising single or repeated interviews with 44 parents of 23 children with incurable cancer. RESULTS We discovered that uncertainty, fragmentation and anxiety underpin the preserving life perspective. A perspective of letting go could be supported by a variety of factors. These included: Certainty that the child cannot be cured, postponed grief, the perception of suffering, the ability to disentangle needs and the ability to parent meaningfully. Hope, creating a peaceful parent-child relationship, and the attitude of professionals, could support movements in either direction. Of these, certainty, and in most cases postponed grief, were pre-conditions for the transition towards letting go. Strategies such as not challenging the parents' suppression of grief, creating certainty about the child's condition and supporting parents in efforts to redefine their parental role, supported progress towards accepting a letting go perspective. CONCLUSIONS Parents' internal struggle between a preserving frame of mind and one of letting go is influenced by a combination of factors. However, professionals can influence some of these factors in order to facilitate this transition.
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Affiliation(s)
- Marijke C Kars
- Department of Nursing Science, University Medical Center Utrecht, Utrecht, The Netherlands.
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Heath JA, Clarke NE, McCarthy M, Donath SM, Anderson VA, Wolfe J. Quality of care at the end of life in children with cancer. J Paediatr Child Health 2009; 45:656-9. [PMID: 19903251 DOI: 10.1111/j.1440-1754.2009.01590.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Current Australian guidelines for the provision of paediatric palliative care highlight the importance of services being focused on the needs of the child and family. We aimed to establish parents' level of satisfaction with the quality of care currently being provided to children dying of cancer. METHODS We interviewed 96 parents of children who died of cancer in Melbourne, Australia between 1996 and 2004 to ascertain how they rated the care provided to their child during the end-of-life period. RESULTS A majority of parents were satisfied with the care provided by their primary oncologist, local doctors, palliative care services and home-care nurses. Most parents felt that discussions about key medical and treatment decisions were appropriate and clearly understood. Parents were generally satisfied with the leadership roles undertaken in decision-making in the end-of-life period; however, parents who were not satisfied indicated that they would like additional involvement of their primary oncologist. CONCLUSIONS Current approaches to end-of-life care in children with cancer appear to be satisfactory. The main focus should continue to be on open and honest communication.
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Affiliation(s)
- John A Heath
- Children's Cancer Centre, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria 3052, Australia.
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25
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Golan H, Bielorai B, Grebler D, Izraeli S, Rechavi G, Toren A. Integration of a palliative and terminal care center into a comprehensive pediatric oncology department. Pediatr Blood Cancer 2008; 50:949-55. [PMID: 18240176 DOI: 10.1002/pbc.21476] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The sharp division between curative cancer therapy and palliative care results in the late introduction of palliative care and a high incidence of suffering in children with cancer. We established a Palliative Care Unit (PCU) that is fully integrated with the Pediatric Hematology Oncology Department (PHOD). We wished to explore the impact of such integrative model on patterns of hospitalizations and exposure to palliative care of pediatric oncology patients. PROCEDURES Retrospective search of medical records of patients admitted to the PHOD since PCU establishment in 1999, and of children who died from progressive disease between 1990 and 2005 was performed. Differences in clinical and prognostic variables between PCU and non-PCU patients, and differences in location of death before and after PCU establishment were evaluated. RESULTS The majority (59%) of patients, who were hospitalized after the PCU establishment, were hospitalized in the PCU, including 49% of the good prognosis patients and 91% of the poor prognosis patients. Poor prognosis patients were hospitalized in the PCU earlier and with higher frequency compared to children with curable disease. After PCU opening there was a significant decline in the percentage of patients who died in the general pediatric ward, hematology-oncology ward, and at home from 40%, 26% and 28% to 4%, 8%, and 16%, respectively. CONCLUSIONS Our integrative model results in exposure of the majority of children with cancer to palliative care. For poor prognosis patients, palliative care is introduced early enough to allow gradual transition from symptom control after diagnosis to end of life care.
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Affiliation(s)
- Hana Golan
- Department of Pediatric Hematology-Oncology, Marion and Elie Wiesel Children's Pavilion, Chaim Sheba Medical Center, Tel-Aviv University Sackler School of Medicine, Ramat Gan, Israel.
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26
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Baker JN, Hinds PS, Spunt SL, Barfield RC, Allen C, Powell BC, Anderson LH, Kane JR. Integration of palliative care practices into the ongoing care of children with cancer: individualized care planning and coordination. Pediatr Clin North Am 2008; 55:223-50, xii. [PMID: 18242323 PMCID: PMC2577813 DOI: 10.1016/j.pcl.2007.10.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Most parents of children with cancer have dual primary goals: a primary cancer-directed goal of cure and a primary comfort-related goal of lessening suffering. Early introduction of palliative care principles and practices into their child's treatment is respectful and supportive of these goals. The Individualized Care Planning and Coordination Model is designed to integrate palliative care principles and practices into the ongoing care of children with cancer. Application of the model helps clinicians to generate a comprehensive individualized care plan that is implemented through Individualized Care Coordination processes as detailed here. Clinicians' strong desire to provide compassionate, competent, and sensitive care to the seriously ill child and the child's family can be effectively translated into clinical practice through these processes.
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Affiliation(s)
- Justin N Baker
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA
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27
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Zieber S, Friebert S. Pediatric cancer care: special issues in ethical decision making. Cancer Treat Res 2008; 140:93-115. [PMID: 18283772 DOI: 10.1007/978-0-387-73639-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Sarah Zieber
- Vanderbilt Children's Hospital, Department of Pediatrics, Nashville, TN 37232-6310, USA
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28
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Abstract
Pediatric medicine is moving toward a greater appreciation that the delivery of quality medical care involves a partnership including the health care team, the child, and the family. Pediatric medicine now emphasizes the importance of information exchange among these groups. This paper discusses two models for communicating with children and their families throughout a complex life-threatening illness. Both models serve as a framework for integrating the medical and nonmedical aspects of the illness experience.
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Affiliation(s)
- Norbert J Weidner
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2001, Cincinnati, OH 45229, USA.
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Grootenhuis MA, Last BF. Children with cancer. RECENT RESULTS IN CANCER RESEARCH. FORTSCHRITTE DER KREBSFORSCHUNG. PROGRES DANS LES RECHERCHES SUR LE CANCER 2006; 168:73-9. [PMID: 17073193 DOI: 10.1007/3-540-30758-3_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Some specific aspects of communication in pediatric oncology will be outlined in this chapter. These include openness about the disease, which has become increasingly important. Furthermore, the law of double protection, a self-protective strategy used by children, parents, and hospital staff, will be sketched out. It is very striking that protection is often achieved through protection of the other. Several examples of this strategy will be presented. Finally, attention will be paid to communication about death in the palliative phase.
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Affiliation(s)
- M A Grootenhuis
- Pediatric Psychosocial Department, Emma Children's Hospital, Amsterdam, The Netherlands
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Freyer DR, Kuperberg A, Sterken DJ, Pastyrnak SL, Hudson D, Richards T. Multidisciplinary care of the dying adolescent. Child Adolesc Psychiatr Clin N Am 2006; 15:693-715. [PMID: 16797445 DOI: 10.1016/j.chc.2006.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The adolescent at the end of life poses a unique combination of challenges resulting from the collision of failing health with a developmental trajectory meant to lead to attainment of personal independence. Because virtually all spheres of the dying adolescent's life are affected, optimal palliative care for these young persons requires a multidisciplinary team whose members have a good understanding of their complementary roles and a shared commitment to providing well-coordinated care. Members of the team include the physician (to initiate and coordinate palliative care management); the nurse (to work collaboratively with the physician and adolescent, especially through effective patient advocacy); the psychologist (to assess and manage the patient's neurocognitive and emotional status); the social worker (to assess and optimize support networks); the chaplain (to support the adolescent's search for spiritual meaning); and the child life specialist (to facilitate effective communication in preparing for death). A crucial area for dying adolescents is medical decision making, where the full range of combined support is needed. By helping the young person continue to develop personal autonomy, the multidisciplinary team will enable even the dying adolescent to experience dignity and personal fulfillment.
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Affiliation(s)
- David R Freyer
- Division of Hematology/Oncology/Bone Marrow Transplantation, DeVos Children's Hospital, 100 Michigan NE, Mailcode 85, Grand Rapids, MI 49503, USA.
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31
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Erby LH, Rushton C, Geller G. "My son is still walking": stages of receptivity to discussions of advance care planning among parents of sons with Duchenne muscular dystrophy. Semin Pediatr Neurol 2006; 13:132-40. [PMID: 17027863 DOI: 10.1016/j.spen.2006.06.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Duchenne muscular dystrophy is an inherited progressive neuromuscular disease that generally results in death by early adulthood. Because of its life-threatening nature, discussions of advance care planning are extremely relevant to families with affected children and adolescents. Seventeen parents of sons with Duchenne muscular dystrophy were interviewed about their attitudes, experiences, and the nature of their discussions about these topics. Parents showed a lack of familiarity with and experience communicating about advance care planning. They also discussed opportunities for communication that centered on transitional life events. Parents appeared to vacillate between hope for future treatments, avoidance of emotionally difficult aspects of the disease, and presence with the fullness of life's experiences. These data suggest a model for future research in which windows of opportunity for discussion may exist as sons are approaching significant transitional milestones and parents are able to see the world through a lens of "presence."
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Affiliation(s)
- Lori Hamby Erby
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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32
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Fowler K, Poehling K, Billheimer D, Hamilton R, Wu H, Mulder J, Frangoul H. Hospice referral practices for children with cancer: a survey of pediatric oncologists. J Clin Oncol 2006; 24:1099-104. [PMID: 16505429 DOI: 10.1200/jco.2005.02.6591] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine hospice referral patterns among pediatric oncologists and identify barriers to referral. METHODS A self-administered survey was sent to 1,200 pediatric oncologists who are members of Children's Oncology Group. Two electronic mail messages followed by traditional mail surveys were sent to eligible physicians. Pediatricians and pediatric oncologists developed, pretested, and modified the survey for item clarification. RESULTS Of 944 eligible pediatric oncologists surveyed, 632 replied, yielding a response rate of 67%. Most respondents reported having access to palliative care programs (65%) and hospice services (85%), but few (27%) had access to inpatient hospice services. More respondents reported feeling comfortable managing end-of-life pain than psychological issues (86% v 67%, respectively). Many pediatric oncologists (62%) reported that half or more of their patients died in the hospital. In multivariate analysis, physicians with access to hospice that accepts patients receiving chemotherapy had more patients die at home than in hospital compared with physicians without access to such services (P = .007). The probability of hospice referral was positively associated with the presence of a hospice facility (P < .001) and with a larger size oncology group (P = .024). Only 2.5% of respondents referred patients at the time of relapse. Continued therapy was cited as the most common reason for not making a referral, and was significantly higher when hospice did not admit children receiving chemotherapy (P = .002). CONCLUSION Hospice referral for children with cancer is usually made late in the course of their disease and might improve if hospice admits patients who are actively receiving chemotherapy.
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Affiliation(s)
- Kimberly Fowler
- Department of Hematology Oncology, University of Alabama, Birmingham, AL, USA
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Abstract
This article reviews the unique challenges of pediatric palliative medicine. These challenges originate from the specific epidemiology of pediatric diseases for which palliative care is indicated and the necessity to provide child-focused, family-oriented, relationship-centered medical care. The emphasis of the ultimate aims of pediatric palliative care is to care for the body, mind, and spirit, to enhance quality of life, and to minimize suffering.
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Affiliation(s)
- Doralina L Anghelescu
- Pain Management Service, Division of Anesthesia, St. Jude Children's Research Hospital, 332 North Lauderdale, Memphis, TN 38105-2794, USA.
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Sourkes B, Frankel L, Brown M, Contro N, Benitz W, Case C, Good J, Jones L, Komejan J, Modderman-Marshall J, Reichard W, Sentivany-Collins S, Sunde C. Food, toys, and love: pediatric palliative care. Curr Probl Pediatr Adolesc Health Care 2005; 35:350-86. [PMID: 16301200 DOI: 10.1016/j.cppeds.2005.09.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Barbara Sourkes
- Pediatric Palliative Care Program, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA 94304-5731, USA.
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Mack JW, Hilden JM, Watterson J, Moore C, Turner B, Grier HE, Weeks JC, Wolfe J. Parent and physician perspectives on quality of care at the end of life in children with cancer. J Clin Oncol 2005; 23:9155-61. [PMID: 16172457 DOI: 10.1200/jco.2005.04.010] [Citation(s) in RCA: 220] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To ascertain parents' and physicians' assessments of quality of end-of-life care for children with cancer and to determine factors associated with high-quality care as perceived by parents and physicians. METHODS A survey was conducted between 1997 and 2001 of 144 parents of children who received treatment at the Dana-Farber Cancer Institute and Children's Hospital (Boston, MA) or Children's Hospitals and Clinics of St Paul and Minneapolis, MN, between 1990 and 1999 (65% of those located and eligible) and 52 pediatric oncologists. RESULTS In multivariable models, higher parent ratings of physician care were associated with physicians giving clear information about what to expect in the end-of-life period (odds ratio [OR] = 19.90, P = .02), communicating with care and sensitivity (OR = 7.67, P < .01), communicating directly with the child when appropriate (OR = 11.18, P < .01), and preparing the parent for circumstances surrounding the child's death (OR = 4.84, P = .03). Parent reports of the child's pain and suffering were not significant correlates of parental ratings of care (P = .93 and .35, respectively). Oncologists' ratings of care were inversely associated with the parent's report of the child's experience of pain (OR = 0.15, P = .01) and more than 10 hospital days in the last month of life (OR = 0.24, P < .01). Parent-rated communication factors were not correlates of oncologist-rated care. No association was found between parent and physician care ratings (P = .88). CONCLUSION For parents of children who die of cancer, doctor-patient communication is the principal determinant of high-quality physician care. In contrast, physicians' care ratings depend on biomedical rather than relational aspects of care.
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Affiliation(s)
- Jennifer W Mack
- Department of Pediatric Oncology, Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA 02115, USA
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36
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37
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Abstract
The care of children with MD presents many complex issues. An interdisciplinary team, focused on patient and family outcome, that incorporates palliative care initiatives can best outline and meet the goals of family-centered care. The early introduction of a palliative team allows for a relationship of trust to develop, serving as the foundation for the many interventions necessary to fill the gaps in care that arise during the care of a child with a chronic, life-threatening illness such as MD.
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Affiliation(s)
- Norbert J Weidner
- StarShine Hospice, Cincinnati Children's Hospital Medical Center, OH 45229-3039, USA.
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38
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Beale EA, Baile WF, Aaron J. Silence Is Not Golden: Communicating With Children Dying From Cancer. J Clin Oncol 2005; 23:3629-31. [PMID: 15908676 DOI: 10.1200/jco.2005.11.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Estela A Beale
- The University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1402, USA
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Friedrichsdorf SJ, Menke A, Brun S, Wamsler C, Zernikow B. Status quo of palliative care in pediatric oncology-a nationwide survey in Germany. J Pain Symptom Manage 2005; 29:156-64. [PMID: 15733807 DOI: 10.1016/j.jpainsymman.2004.05.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2004] [Indexed: 01/02/2023]
Abstract
Cancer is the leading cause of death among the pediatric population with life-limiting conditions. The provision of palliative care at home and on the children's cancer unit has not been surveyed previously on a national scale. A survey of 71 (of 73) German pediatric oncology units (response rate 97%) provided information on the timing of breaking bad news, place of death, orchestrating palliative care at home and on the ward, integration of services and staff, funding of palliative care, bereavement services for siblings and parents, educational needs, level of self-satisfaction, and designated integrated palliative care services for children with cancer. More than 60% of children with malignancies died as inpatients in 2000, fewer than 40% at home. Twenty-nine pediatric cancer departments were able to provide comprehensive medical palliative home care, and nine units incorporate a designated palliative care team or person. Only half of the departments provide bereavement services for siblings. Many health professionals working on pediatric cancer units in Germany provide palliative home care in their free time without any payment. They predominantly use their private vehicles and often are unclear about the legal background and insurance arrangements covering their provision of care. The data suggest an important need for education about palliative and end-of-life care. The majority of children dying from cancer in Germany do not have access to comprehensive palliative care services at home. Our study highlights the necessity of incorporating the palliative paradigm into the care of children with cancer. Barriers to its implementation must be identified and overcome.
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Affiliation(s)
- Stefan J Friedrichsdorf
- Vest Children's Hospital, Institute of Children's Pain Management and Pediatric Palliative Care, University of Witten/Herdecke, Datteln, Germany
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Abstract
OBJECTIVES To describe the complexities in end-of-life care of children and adolescents dying cancer-related deaths. DATA SOURCES Research studies, review articles, and government reports. CONCLUSION The complexities in providing competent and compassionate care to the dying child and the family is intense, undeniable, and may in some clinical situations be unavoidable. IMPLICATIONS FOR NURSING PRACTICE It is important for all those involved with the care at the end of life for a child or adolescent dying a cancer-related death create the framework that will support the provikion of competent and compassionate end-of-life care.
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Affiliation(s)
- Pamela S Hinds
- Division of Nursing Research, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
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41
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Ulrich CM, Grady C, Wendler D. Palliative care: a supportive adjunct to pediatric phase I clinical trials for anticancer agents? Pediatrics 2004; 114:852-5. [PMID: 15342863 DOI: 10.1542/peds.2003-0913-l] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Connie M Ulrich
- Department of Clinical Bioethics, Warren G. Magnuson Clinical Center National Institutes of Health Bethesda, MD 20892, USA.
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