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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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Kwete XJ, Bhadelia A, Arreola-Ornelas H, Mendez O, Rosa WE, Connor S, Downing J, Jamison D, Watkins D, Calderon R, Cleary J, Friedman JR, De Lima L, Ntizimira C, Pastrana T, Pérez-Cruz PE, Spence D, Rajagopal MR, Vargas Enciso V, Krakauer EL, Radbruch L, Knaul FM. Global Assessment of Palliative Care Need: Serious Health-Related Suffering Measurement Methodology. J Pain Symptom Manage 2024:S0885-3924(24)00708-5. [PMID: 38636816 DOI: 10.1016/j.jpainsymman.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/05/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
CONTEXT Inequities and gaps in palliative care access are a serious impediment to health systems especially in low- and middle-income countries and the accurate measurement of need across health conditions is a critical step to understanding and addressing the issue. Serious Health-related Suffering (SHS) is a novel methodology to measure the palliative care need and was originally developed by The Lancet Commission on Global Access to Palliative Care and Pain Relief. In 2015, the first iteration - SHS 1.0 - was estimated at over 61 million people worldwide experiencing at least 6 billion days of SHS annually as a result of life-limiting and life-threatening conditions. OBJECTIVES In this paper, an updated methodology - SHS 2.0 - is presented building on the work of the Lancet Commission and detailing calculations, data requirements, limitations, and assumptions. METHODS AND RESULTS The updates to the original methodology focus on measuring the number of people who die with (decedents) or live with (non-decedents) SHS in a given year to assess the number of people in need of palliative care across health conditions and populations. Detail on the methodology for measuring the number of days of SHS that was pioneered by the Lancet Commission, is also shared, as this second measure is essential for determining the health system responses that are necessary to address palliative care need and must be a priority for future methodological work on SHS. CONCLUSIONS The methodology encompasses opportunities for applying SHS to future policy making assessment of future research priorities particularly in light of the dearth of data from low- and middle-income countries, and sharing of directions for future work to develop SHS 3.0.
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Affiliation(s)
- Xiaoxiao J Kwete
- University of Miami Institute for Advanced Study of the Americas, University of Miami (X.J.K., A.B., H.A.-O., W.E.R., R.C., V.V.E., F.M.K.), Miami, Florida, USA; Yangzhou Philosophy and Social Science Research and Communication Center (X.J.K.), Yangzhou, China.
| | - Afsan Bhadelia
- University of Miami Institute for Advanced Study of the Americas, University of Miami (X.J.K., A.B., H.A.-O., W.E.R., R.C., V.V.E., F.M.K.), Miami, Florida, USA; Department of Public Health, College of Health and Human Sciences (A.B.), Purdue University, West Lafayette, Indiana, USA
| | - Héctor Arreola-Ornelas
- University of Miami Institute for Advanced Study of the Americas, University of Miami (X.J.K., A.B., H.A.-O., W.E.R., R.C., V.V.E., F.M.K.), Miami, Florida, USA; Institute for Obesity Research, Tecnologico de Monterrey (H.A.-O.), Monterrey, Mexico; School of Government and Public Transformation, Tecnologico de Monterrey, Mexico City, Mexico; Tómatelo a Pecho, A.C. (H.A-O., O.M., F.M.K.), Mexico City, Mexico; Fundación Mexicana para la Salud (FUNSALUD) (H.A.-O.), Mexico City, México
| | - Oscar Mendez
- Tómatelo a Pecho, A.C. (H.A-O., O.M., F.M.K.), Mexico City, Mexico
| | - William E Rosa
- University of Miami Institute for Advanced Study of the Americas, University of Miami (X.J.K., A.B., H.A.-O., W.E.R., R.C., V.V.E., F.M.K.), Miami, Florida, USA; Department of Psychiatry and Behavioral Sciences (W.E.R.), Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Stephen Connor
- Worldwide Hospice Palliative Care Alliance (S.C.), London, UK
| | - Julia Downing
- International Children's Palliative Care Network (J.D.), Bristol, UK
| | - Dean Jamison
- University of California (D.J.), San Francisco, California, USA
| | - David Watkins
- Department of Global Health, University of Washington (D.W.), Seattle, Washington, USA
| | - Renzo Calderon
- University of Miami Institute for Advanced Study of the Americas, University of Miami (X.J.K., A.B., H.A.-O., W.E.R., R.C., V.V.E., F.M.K.), Miami, Florida, USA
| | - Jim Cleary
- Indiana University School of Medicine (J.C.), Indianapolis, Indiana, USA
| | - Joseph R Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles, California, USA
| | - Liliana De Lima
- International Association of Hospice and Palliative Care (L.D.L.), Houston, Texas, USA
| | | | - Tania Pastrana
- International Association of Hospice and Palliative Care (L.D.L.), Houston, Texas, USA; Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Pedro E Pérez-Cruz
- Sección Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro para la Prevención y el Control del Cáncer (CECAN), Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Valentina Vargas Enciso
- University of Miami Institute for Advanced Study of the Americas, University of Miami (X.J.K., A.B., H.A.-O., W.E.R., R.C., V.V.E., F.M.K.), Miami, Florida, USA
| | - Eric L Krakauer
- Department of Global Health & Social Medicine, Harvard Medical School (E.L.K.), Boston, Massachusetts, USA
| | - Lukas Radbruch
- International Association of Hospice and Palliative Care (L.D.L.), Houston, Texas, USA; Department of Palliative Medicine, University Hospital Bonn, Germany
| | - Felicia Marie Knaul
- University of Miami Institute for Advanced Study of the Americas, University of Miami (X.J.K., A.B., H.A.-O., W.E.R., R.C., V.V.E., F.M.K.), Miami, Florida, USA; Tómatelo a Pecho, A.C. (H.A-O., O.M., F.M.K.), Mexico City, Mexico; Sylvester Comprehensive Cancer Center, Miller School of Medicine (F.M.K.), University of Miami, Miami, Florida, USA; Leonard M. Miller School of Medicine (F.M.K.), University of Miami, Miami, Florida, USA
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Ellis D, Mazzola E, Wolfe J, Kelleher C. Comparing Pediatric Surgeons' and Palliative Care Pediatricians' Palliative Care Practices and Perspectives in Pediatric Surgical Patients. J Pediatr Surg 2024; 59:37-44. [PMID: 37827879 DOI: 10.1016/j.jpedsurg.2023.09.011] [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: 08/13/2023] [Accepted: 09/06/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE The nature of interactions between surgical and pediatric palliative care (PPC) teams caring for seriously ill children is unknown. This study compares pediatric surgeons' and PPC physicians' perspectives and practices regarding PPC in surgical patients. METHODS A survey was administered to members of the American Pediatric Surgical Association and Pediatric Interest Group of the American Academy of Hospice and Palliative Medicine. RESULTS One hundred twenty-four pediatric surgeons (31% female, 17.2 mean years of experience) and 71 PPC physicians (69% female, 10.1 mean years of experience) participated. Forty-three percent of surgeons reported consulting PPC often for children with serious illnesses. However, most PPC physicians (67%), said they are rarely/never consulted by surgeons (p = 0.002). PPC physicians were more likely to report that PPC involvement was too late (43% vs 21%, p = 0.005). More surgeons than PPC physicians felt that an appropriate time for PPC consultation was during serious illness deterioration (30% vs 7%, p = 0.05), whereas PPC physicians preferred consultation at diagnosis (54% vs 34%, p = 0.05). More PPC physicians (67%) than surgeons (17%) agreed that invasive interventions could be considered a form of PPC (p = 0.002). The most reported barrier to PPC consultation by surgeons (29%) was concern that parents would think the surgical team was giving up. PPC physicians were more likely to perceive barriers to consultation by surgeons than surgeons themselves (p < 0.001). CONCLUSION While pediatric surgeons value PPC involvement, surgical culture and misperception of parental resistance to PPC involvement lead to palliative care consultation only when illness acuity and severity are high, the possibility of curability is low, and death seems imminent. Seeking to understand patient and family priorities in care, managing patient and parental psychological distress, and treating non-surgical symptoms are areas where PPC can improve patient care. Barriers to PPC use and self-reported knowledge gaps in PPC provision may be mitigated by formalized PPC training for surgeons and intentional collaboration between the two groups. TYPE OF STUDY Survey. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Danielle Ellis
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA.
| | - Emanuele Mazzola
- Department of Data Science, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Joanne Wolfe
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cassandra Kelleher
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
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Goswami J, Baxter J, Schiltz BM, Elsbernd TA, Arteaga GM, Klinkner DB. Optimizing resource utilization: palliative care consultations in critically ill pediatric trauma patients. Trauma Surg Acute Care Open 2023; 8:e001143. [PMID: 38020850 PMCID: PMC10660420 DOI: 10.1136/tsaco-2023-001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives The American College of Surgeons Trauma Quality Improvement Program (TQIP) and Committee on Trauma released a best practice guideline for palliative care in trauma patients in 2017. Utilization of pediatric palliative care services for pediatric trauma patients has not been studied. We sought to identify patients who received the consultation and develop criteria for patients who would benefit from these resources at our institution. Methods The institutional pediatric trauma registry was queried to identify all admissions age 0-17 years old to the pediatric intensive care unit (PICU) or trauma ICU (TICU) from 2014 to 2021. Demographic and clinical features were obtained from the registry. Electronic medical records were reviewed to identify and review consultations to the ComPASS team. A clinical practice guideline (CPG) for palliative care consultations was developed based on the TQIP guideline and applied retrospectively to patients admitted 2014-2021. The CPG was then prospectively applied to patients admitted from March through November 2022. Results A total of 399 patients were admitted to the PICU/TICU. There were 30 (7.5%) deaths, 20 (66.7%) within 24 hours of admission. Palliative care consultations were obtained in 21 (5.3%). Of these, 10 (47.6%) patients were infants/toddlers Conclusion Our results demonstrate underused potential of the palliative care team to impact the hospital course of critically ill pediatric trauma patients. Ongoing studies will analyze the utility of CPG implementation for early involvement of palliative services in critically ill pediatric trauma patients. Level of Evidence Level III (retrospective cohort).
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Affiliation(s)
- Julie Goswami
- Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Rutgers Acute Care Surgery Research (RASR) Lab, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jacob Baxter
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Grace M Arteaga
- Department of Pediatrics, Mayo Clinic, Rochester, New York, USA
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5
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Lee A, DeGroote NP, Brock KE. Early Versus Late Outpatient Pediatric Palliative Care Consultation and Its Association With End-of-Life Outcomes in Children With Cancer. J Palliat Med 2023; 26:1466-1473. [PMID: 37222727 DOI: 10.1089/jpm.2023.0063] [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] [Indexed: 05/25/2023] Open
Abstract
Background: There is no consensus on what constitutes "early" pediatric palliative care (PPC) referral within pediatric oncology. Few studies report outcomes based on PPC timing. Objectives: Investigate associations between early (<12 weeks) or late (≥12 weeks from diagnosis) outpatient PPC consultation with demographics, advance care planning (ACP), and end-of-life (EOL) outcomes. Design: Retrospective chart and database review of demographic, disease, visit data, and PPC/EOL outcomes. Setting/Subjects: Deceased pediatric patients with cancer 0-27 years of age seen at an embedded consultative PPC clinic. Measurements: Patient demographics, disease characteristics, PPC/EOL outcomes: timing/receipt of ACP, hospice enrollment, do-not-resuscitate (DNR) documentation, hospital days in last 90 days of life, concordance between actual and preferred location of death, receipt of cardiopulmonary resuscitation (CPR) at EOL, and death in the intensive care unit. Results: Thirty-two patients received early and 118 received late PPC. Early outpatient PPC was associated with cancer type (p < 0.01). Early PPC (p = 0.04) and ACP documentation (p = 0.04) were associated with documentation of preferred location of death. Early PPC was associated with a preference for home death (p = 0.02). Timing of outpatient PPC was not associated with ACP documentation or other EOL outcomes. In the entire cohort, 73% of PPC patients received hospice, 74% had a DNR order, 87% did not receive CPR at EOL, and 90% died in their preferred location. Conclusions: When using a cutoff of 12 weeks from diagnosis, outpatient PPC timing was only associated with location of death metrics, likely due to high-quality PPC and EOL care among all patients.
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Affiliation(s)
- Annika Lee
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nicholas P DeGroote
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Katharine E Brock
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Divisions of Pediatric Hematology/Oncology and Palliative Care, Emory University, Atlanta, Georgia, USA
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Walker M, Nicolardi D, Christopoulos T, Ross T. Hospital, hospice, or home: A scoping review of the importance of place in pediatric palliative care. Palliat Support Care 2023; 21:925-934. [PMID: 37357946 DOI: 10.1017/s1478951523000664] [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] [Indexed: 06/27/2023]
Abstract
BACKGROUND Palliative care necessitates questions about the preferred place for delivering care and location of death. Place is integral to palliative care, as it can impact proximity to family, available resources/support, and patient comfort. Despite the importance of place, there is remarkably little literature exploring its role in pediatric palliative care (PPC). OBJECTIVES To understand the importance and meaning of place in PPC. METHODS We conducted a scoping review to understand the importance of place in PPC. Five databases were searched using keywords related to "pediatric," "palliative," and "place." Two reviewers screened results, extracted data, and analyzed emergent themes pertaining to place. RESULTS From 3076 search results, we identified and reviewed 25 articles. The literature highlights hospital, home, and hospice as 3 distinct PPC places. Children and their families have place preferences for PPC and place of death, and a growing number prefer death to occur at home. Results also indicate numerous factors influence place preferences (e.g., comfort, grief, cultural/spiritual practices, and socioeconomic status). SIGNIFICANCE OF RESULTS Place influences families' PPC decisions and experiences and thus warrants further study. Greater understanding of the importance and roles of place in PPC could enhance PPC policy and practice, as well as PPC environments.
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Affiliation(s)
- Meaghan Walker
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Danielle Nicolardi
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Téa Christopoulos
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Timothy Ross
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Geography & Planning, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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Pitch N, Shahil A, Mekhuri S, Ambreen M, Chu S, Keilty K, Cohen E, Orkin J, Amin R. Caring for children with new medical technology at home: parental perspectives. BMJ Paediatr Open 2023; 7:e002062. [PMID: 37865398 PMCID: PMC10603509 DOI: 10.1136/bmjpo-2023-002062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/04/2023] [Indexed: 10/23/2023] Open
Abstract
OBJECTIVES This qualitative descriptive study explores the experiences of family caregivers (FCs) of children with medical complexity who are initiated on new medical technology in the hospital and transition to new daily life at home. The study aims to investigate FCs' response and readiness for medical technology use, the value of education and transition support and the challenges associated with managing new medical technology in the home. STUDY DESIGN A qualitative descriptive approach was used to conduct and analyse 14 semistructured interviews with a group of FCs composed of 11 mothers and 3 fathers. Content analysis was used to analyse transcripts of the caregiver interviews. The study was conducted at a tertiary paediatric hospital in Toronto, Canada. RESULTS Our study revealed three main themes: FC's response and readiness for medical technology use, the value of education and transition support for initiation of new medical technology and the challenges associated with managing new medical technology in the home. FCs expressed emotional distress related to coping with the realisation that their child required medical technology. Although the theoretical and hands-on practice training instilled confidence in families, FCs reported feeling overwhelmed when they transitioned home with new medical technology. Finally, FCs reported significant psychological, emotional and financial challenges while caring for their technology-dependent child. CONCLUSIONS Our study reveals the unique challenges faced by FCs who care for technology-dependent children. These findings highlight the need to implement a comprehensive education and transition programme that provides longitudinal support for all aspects of care.
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Affiliation(s)
- Natalie Pitch
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anam Shahil
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Mekhuri
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Munazzah Ambreen
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephanie Chu
- Connected Care, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Krista Keilty
- Connected Care, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Julia Orkin
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Langmann G, Maurer S. Anxiety in Seriously Ill Children and Adolescents: Definitions and Assessment #465. J Palliat Med 2023; 26:1419-1420. [PMID: 37788471 DOI: 10.1089/jpm.2023.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
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9
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Langmann G, Maurer S. Acute Anxiety in Seriously Ill Children and Adolescents: Management #466. J Palliat Med 2023; 26:1421-1422. [PMID: 37788472 DOI: 10.1089/jpm.2023.0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
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Levine A, Winn PA, Fogel AH, Lelkes E, McPoland P, Agrawal AK, Bogetz JF. Barriers to Pediatric Palliative Care: Trainee and Faculty Perspectives Across Two Academic Centers. J Palliat Med 2023; 26:1348-1356. [PMID: 37318791 PMCID: PMC10623063 DOI: 10.1089/jpm.2022.0580] [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] [Accepted: 04/14/2023] [Indexed: 06/16/2023] Open
Abstract
Objective: Barriers to palliative care for children with serious illness include system constraints and vastly different training and attitudes toward palliative care. This study aimed to explore trainee and faculty physician perceptions of barriers to palliative care across two pediatric centers to (1) examine differences between trainees and faculty and (2) compare these data with previous studies. Methods: A mixed-methods study was conducted in fall 2021 among pediatric trainees and faculty physicians at three pediatric hospitals in two pediatric centers in the western United States. Surveys were distributed through hospital listservs and analyzed descriptively and through inductive thematic analysis. Results: There were a total of 268 participants: 50 trainees and 218 faculty physicians. Of the trainees, 46% (23) were fellows and 54% (27) were pediatric residents. Trainees and faculty reported the same four most common barriers, which were consistent with previous studies: family not ready to acknowledge an incurable condition (64% trainees and 45% faculty); family preference for more life-sustaining therapies than staff (52% and 39%); uncertain prognosis (48% and 38%); and parent discomfort with possibility of hastening death (44% and 30%). Other barriers commonly reported included time constraints, staff shortages, and conflict among family about treatment goals. Language barriers and cultural differences were also cited. Conclusions: This study examining palliative care across two pediatric centers suggests that providers' perceptions of family preferences and understanding of illness persist as barriers to the delivery of pediatric palliative care services. Future research should examine family-centered and culturally mindful interventions to better elucidate family perspectives on their child's illness to align care.
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Affiliation(s)
- Alyssa Levine
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Phoebe A. Winn
- Divisions of Emergency Medicine and Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Alexis H. Fogel
- Divisions of Emergency Medicine and Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Efrat Lelkes
- Division of Pediatric Critical Care, Benioff Children's Hospital San Francisco, University of California, San Francisco, San Francisco, California, USA
| | - Paula McPoland
- Division of Pediatric Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Anurag K. Agrawal
- Divisions of Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Jori F. Bogetz
- Division of Pediatric Bioethics and Palliative Care, Department of Pediatrics, Center for Clinical and Translational Research, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Washington, USA
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11
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Cai S, Guo Q, Lin J, Deng C, Li H, Zhou X. The dignity of terminally ill children in pediatric palliative care: perspectives of parents and healthcare providers. BMC Palliat Care 2023; 22:86. [PMID: 37407969 DOI: 10.1186/s12904-023-01206-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The Chochinov Dignity Model was developed based on a cohort of adult patients with advanced cancer, but its role among dying children is not clear. This study aims to develop a model of dignity for children receiving pediatric palliative care based on the Chochinov Dignity Model. METHODS This is a descriptive qualitative study. Participants included a total of 11 parents and 14 healthcare providers who were recruited from a tertiary children's hospital in Beijing and the Pediatric Palliative Care Subspecialty Group of the Pediatrics Society of the Chinese Medical Association using purposive sampling. Thematic framework analysis was used to analyze data. RESULTS The themes of the empirical Dignity Model were broadly supported in this study, but some themes were interpreted differently in the child population. Compared with the original model, some child-specific themes were identified including acknowledging regret, a sense of security, the company of important loved ones, realizing unfinished wishes, decent and dignified death, resolving family disputes, and fairness. CONCLUSIONS This is the first study on Dignity Model for terminal children. Knowledge of children's dignity can promote reflection of healthcare providers and caregivers regarding the values underlying their performance in pediatric palliative care, and develop certain practical interventions to strengthen children and their families' sense of dignity at end of life.
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Affiliation(s)
- Siyu Cai
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Qiaohong Guo
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Fengtai District, Beijing, 100069, China.
| | - Junyi Lin
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Fengtai District, Beijing, 100069, China
| | - Chanjuan Deng
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Fengtai District, Beijing, 100069, China
| | - Huijun Li
- Department of Nursing, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xuan Zhou
- Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Hematology Center, Beijing Children's Hospital, National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Capital Medical University, National Center for Children's Health, 56 South Lishi Road, Xicheng District, Beijing, 100045, China.
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12
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Stoesslein S, Gramm JD, Bender HU, Müller P, Rabenhorst D, Borasio GD, Führer M. "More life and more days"-patient and care characteristics in a specialized acute pediatric palliative care inpatient unit. Eur J Pediatr 2023; 182:1847-1855. [PMID: 36795188 PMCID: PMC10167193 DOI: 10.1007/s00431-023-04813-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/30/2022] [Accepted: 01/06/2023] [Indexed: 02/17/2023]
Abstract
UNLABELLED Only a few acute hospital inpatient units dedicated to pediatric palliative care (PPC) patients exist today. Clinical data on the patients and care provided at specialized acute PPC inpatient units (PPCUs) are scarce. This study aims at describing patient and care characteristics on our PPCU to learn about the complexity and relevance of inpatient PPC. A retrospective chart analysis was performed on the 8-bed PPCU of the Center for Pediatric Palliative Care of the Munich University Hospital, including demographic, clinical, and treatment characteristics (487 consecutive cases; 201 individual patients; 2016-2020). Data were analyzed descriptively; the chi-square test was used for comparisons. Patients' age (1-35.5 years, median: 4.8 years) and length of stay (1-186 days, median 11 days) varied widely. Thirty-eight percent of patients were admitted repeatedly (range 2-20 times). Most patients suffered from neurological diseases (38%) or congenital abnormalities (34%); oncological diseases were rare (7%). Patients' predominant acute symptoms were dyspnea (61%), pain (54%), and gastrointestinal symptoms (46%). Twenty percent of patients suffered from > 6 acute symptoms, 30% had respiratory support incl. invasive ventilation, 71% had a feeding tube, and 40% had full resuscitation code. In 78% of cases, patients were discharged home; 11% died on the unit. CONCLUSION This study shows the heterogeneity, high symptom burden, and medical complexity of the patients on the PPCU. The high dependency on life-sustaining medical technology points to the parallelism of life-prolonging and palliative treatments that is typical for PPC. Specialized PPCUs need to offer care at the intermediate care level in order to respond to the needs of patients and families. WHAT IS KNOWN • Pediatric patients in outpatient PPC or hospices present with a variety of clinical syndromes and different levels of complexity and care intensity. • There are many children with life-limiting conditions (LLC) in hospitals, but specialized PPC hospital units for these patients are rare and poorly described. WHAT IS NEW • Patients on a specialized PPC hospital unit show a high symptom burden and a high level of medical complexity, including dependency on medical technology and frequent full resuscitation code. • The PPC unit is mainly a place for pain and symptom management as well as crisis intervention, and needs to be able to offer treatment at the intermediate care level.
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Affiliation(s)
- Sophie Stoesslein
- Center for Pediatric Palliative Care, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Marchioninistraße 15, Munich, 81377, Germany
| | - Julia D Gramm
- Center for Pediatric Palliative Care, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Marchioninistraße 15, Munich, 81377, Germany
| | - Hans-Ulrich Bender
- Center for Pediatric Palliative Care, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Marchioninistraße 15, Munich, 81377, Germany.,Pediatric Palliative Care, Department of Pediatrics, Bern University Hospital, Bern, Switzerland
| | - Petra Müller
- Center for Pediatric Palliative Care, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Marchioninistraße 15, Munich, 81377, Germany
| | - Dorothee Rabenhorst
- Center for Pediatric Palliative Care, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Marchioninistraße 15, Munich, 81377, Germany
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Monika Führer
- Center for Pediatric Palliative Care, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Marchioninistraße 15, Munich, 81377, Germany.
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13
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Hasan F, Weingarten K, Cada M, Wilejto M. Palliative Care Training for Pediatric Hematology/Oncology Fellows: a Canadian Perspective. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:167-174. [PMID: 34591268 DOI: 10.1007/s13187-021-02094-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 06/13/2023]
Abstract
Children with cancer experience suffering, particularly at the end of life. Pediatric hematology/oncology (PHO) fellows need dedicated palliative care (PC) training in order to adequately manage this suffering. Our objectives were to understand (1) the PC training needs of Canadian PHO fellows and (2) experiences in providing PC, from the perspectives of fellows and their training program directors (PDs) and to describe (1) our experience in enhancing our institutional PC curriculum and (2) the preliminary evaluation of this curriculum. Electronic surveys were sent to all Canadian PHO fellows and PDs. Fellows participating in our curriculum were also sent post-course surveys. All 9/9 of the PDs and 63% (29/46) of the fellows completed our pre-course surveys. The majority of survey participants agreed that PHO fellows require dedicated PC training. All programs provided some PC education, but 45% of programs offered 3 or fewer hours of training per year. Only 55% (5/9) of the PDs believed that their trainees had adequate PC skills on completion of training. Fellows perceived a range of PC skills to be important but expressed low levels of comfort across these skills. Many fellows had experienced distress as a result of managing PC clinical situations, and many cited a lack of training as contributing to their distress. Despite increasing awareness of the importance of PC education for PHO fellows, this subject does not receive adequate attention in training curricula. The introduction of a Canadian national curriculum may improve the provision of PC training in education programs.
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Affiliation(s)
- Fyeza Hasan
- Division of Paediatric Haematology and Oncology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, M5G1X8, Canada.
| | - Kevin Weingarten
- Division of Paediatric Haematology and Oncology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, M5G1X8, Canada
- Paediatric Advanced Care Team, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G1X8, Canada
| | - Michaela Cada
- Division of Paediatric Haematology and Oncology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, M5G1X8, Canada
| | - Marta Wilejto
- Division of Paediatric Haematology/Oncology, Children's Hospital, London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
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14
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Madni A, Porter AS, Crook K, Cartwright C, Hakim H. Feeding the Family: Cultural Humility in Bereavement Care. Pediatrics 2022; 150:189809. [PMID: 36317489 DOI: 10.1542/peds.2021-055874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 12/04/2022] Open
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15
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Cho-Hee K, Min-Sun K, Yi-Ji M, Hee-Young S, Myung-Nam L, Kyung-Ah K. Content Analysis of Multifaceted Needs for Improving the Quality of Pediatric Palliative Care Among Parents of Children With Life-threatening Conditions. J Hosp Palliat Nurs 2022; 24:00129191-990000000-00047. [PMID: 36253898 DOI: 10.1097/njh.0000000000000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to identify parental needs for pediatric palliative care and obtain their opinions on developing pediatric palliative care in South Korea. This qualitative research design used inductive and deductive methods. The data were collected through semistructured interviews. A total of 6 parents actively caring for a child with life-threatening conditions and 7 bereaved parents participated in this study. A total of 707 significant statements, 43 subthemes, and 16 themes according to 6 structured matrices (advance care planning and symptom control, psychological and spiritual care, supporting everyday lives, end-of-life care and bereavement support, delivery model of pediatric palliative care, and unmet needs within current services) on the care and bereavement experiences of parents of children with life-threatening conditions were derived. Palliative care for children is a multidisciplinary approach to evaluate, prevent, and manage multifaceted symptoms and to support children with life-threatening conditions and their families. Our findings suggest that parents of children with life-threatening conditions in South Korea present multidimensional needs across the diagnostic groups and the illness trajectories and inform policy makers and health care professionals to design a pediatric palliative care delivery model. Further studies examining the unmet needs are required to enhance the quality of pediatric palliative care.
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16
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Wager J, Kubek LA, Brenner M, Calmanti S, Doyle C, Lövgren M, Kreicbergs U, Kremer L, Le Moine P, Robert G, Schuiling-Otten M, Schröder-Bäck P, Verhagen E, Zernikow B. Expert survey on coverage and characteristics of pediatric palliative care in Europe - a focus on home care. BMC Palliat Care 2022; 21:185. [PMID: 36244981 PMCID: PMC9575204 DOI: 10.1186/s12904-022-01078-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background For children with life-limiting conditions home care is a key component of pediatric palliative care. However, poor information is available on service coverage and in particular on country-specific pediatric palliative home care characteristics. The aim of the study was therefore to describe the association between pediatric palliative care coverage and national activities and obtain detailed information on the pediatric palliative home care structure in different European countries. Methods Online survey with in-country experts from N = 33 European countries. Results Pediatric palliative home care (65.6%) represented the most pediatric palliative care units (15.6%) and the least common services. National documents constituted the most widespread national pediatric palliative care activity (59.4%) and were associated with available services. Pediatric palliative home care could be mostly accessed as a service free of charge to families (95.2%) from the time of a child's diagnosis (85.7%). In most countries, oncological and non-oncological patients were cared for in pediatric palliative home care. Only a minority of home care teams covered home-ventilated children. Pediatric palliative home care usually comprised medical care (81.0%), care coordination (71.4%), nursing care (75.0%) and social support (57.1%). Most countries had at least two professional groups working in home care teams (81.0%), mostly physicians and nurses. In many countries, pediatric palliative home care was not available in all regions and did not offer a 24 h-outreach service. Conclusions Pediatric palliative care provision in Europe is heterogeneous. Further work on country-specific structures is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01078-0.
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Affiliation(s)
- Julia Wager
- PedScience Research Institute, Herdieckstraße 5b, 45711, Datteln, Germany.,Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Larissa Alice Kubek
- PedScience Research Institute, Herdieckstraße 5b, 45711, Datteln, Germany. .,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.
| | - Maria Brenner
- School of Nursing, Midwifery & Health Systems, University College, Dublin, Ireland
| | - Sara Calmanti
- Accompagnement Et Information (CREAI) en Faveur Des Populations Vulnérables, Centre Régional d'Etudes, Bretagne, France
| | - Carmel Doyle
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | | | | | - Leontien Kremer
- Princess Máxima Center for Pediatric Oncology, 3584 CS, Utrecht, The Netherlands
| | - Philippe Le Moine
- Equipe Ressource Régionale de Soins Palliatifs Pédiatriques La BRISE, Bretagne, France
| | - Guillaume Robert
- Equipe Ressource Régionale de Soins Palliatifs Pédiatriques La BRISE, Bretagne, France
| | | | - Peter Schröder-Bäck
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Eduard Verhagen
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boris Zernikow
- PedScience Research Institute, Herdieckstraße 5b, 45711, Datteln, Germany.,Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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17
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Moyer KM, Verbeck N, Barnett MD, Denney-Koelsch EM, Ajayi T, Humphrey LM, Malhotra S, Ragsdale L, Waldman ED, Gustin JL. A National Survey to Guide Pediatric Curricula for Hospice and Palliative Medicine Fellows. J Pain Symptom Manage 2022; 64:e165-e171. [PMID: 35523388 DOI: 10.1016/j.jpainsymman.2022.04.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/08/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Kristen M Moyer
- Hospice and Community Care (K.M.M.), Lancaster, Pennsylvania, USA.
| | - Nicole Verbeck
- The Ohio State University College of Medicine (N.V.), Columbus, Ohio, USA
| | - Michael D Barnett
- University of Alabama at Birmingham (M.D.B.), Birmingham, Alabama, USA
| | | | - Toluwalase Ajayi
- Scripps Health and Rady Children's Hospital (T.A.), San Diego, California, USA
| | - Lisa M Humphrey
- Nationwide Children's Hospital (L.M.H.), Columbus, Ohio, USA
| | - Sonia Malhotra
- Tulane University School of Medicine and Louisiana State University School of Medicine (S.M.), New Orleans, Los Angeles, USA
| | - Lindsay Ragsdale
- University of Kentucky College of Medicine (L.R.), Lexington, Kentucky, USA
| | - Elisha D Waldman
- Northwestern University School of Medicine / Ann & Robert H. Lurie Children's Hospital of Chicago (E.D.W.), Chicago, Illinois, USA
| | - Jillian L Gustin
- The Ohio State University Wexner Medical Center (J.L.G.), Columbus, Ohio, USA
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18
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Bogetz JF, Anderson A, Holland M, Macauley R. Pediatric Hospice and Palliative Care Services and Needs Across the Northwest United States. J Pain Symptom Manage 2022; 64:e7-e14. [PMID: 35192876 DOI: 10.1016/j.jpainsymman.2022.02.015] [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: 11/05/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 11/20/2022]
Abstract
CONTEXT Given workforce and funding constraints, pediatric hospice and palliative care clinicians often find challenges providing services for seriously ill children and families, particularly in low resource and rural/remote areas. OBJECTIVES To describe the services, training, and education needs of pediatric hospice and palliative care programs across the Northwest United States as part of the formation of a new regional coalition. METHODS Electronic surveys were sent to pediatric hospice and palliative care clinicians through state organizations as part of an email invitation to join the Northwest Pediatric Palliative Care Coalition. Data were analyzed descriptively using univariate analysis. RESULTS Sixty-four participants representing 37 unique programs responded from seven states, including Washington (41%, n=27), Oregon (38%, n=25), Idaho (11%, n=7), Alaska (5%, n=3), Montana (3%, n=2), Colorado (2%, n=1), and Nevada (2%, n=1). Programs provided pediatric hospice care (42%, n=33/78) and palliative care services (30%, n=26/86). Although 26% (n=15/58) had been providing pediatric hospice and palliative care for >20 years, 40% (n=21/53) reported only serving <5 pediatric patients per year. Specific services provided included pediatric bereavement support (16%, n=37/231), telehealth (14%, n=33/231), and respite (10%, n=23/231). Barriers occurring always, often, or sometimes included lack of trained staff (84%), financial support (59%), and access to home infusions (48%). From the coalition, participants prioritized education on parent/caregiver psychosocial support (40%, n=19/48), goals of care communication (44%, n=21/48), and symptom management (45%, n=21/47). CONCLUSIONS Pediatric hospice and palliative care clinicians face numerous barriers and may benefit from a coalition that provides networking and tailored education.
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Affiliation(s)
- Jori F Bogetz
- Division of Bioethics and Palliative Care, Department of Pediatrics, Palliative Care and Resilience Lab, Center for Clinical and Translational Research, University of Washington School of Medicine, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA.
| | - Anne Anderson
- Pediatric Palliative Care Team, Seattle Children's Hospital, Seattle, Washington, USA
| | - Monica Holland
- Bridges Pediatric Palliative Care Program, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
| | - Robert Macauley
- Oregon Health and Science University School of Medicine, Director, Bridges Pediatric Palliative Care Program, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
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19
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García-Quintero X, Claros-Hulbert A, Tello-Cajiao ME, Bolaños-Lopez JE, Cuervo-Suárez MI, Durán MGG, Gómez-García W, McNeil M, Baker JN. Using EmPalPed-An Educational Toolkit on Essential Messages in Palliative Care and Pain Management in Children-As a Strategy to Promote Pediatric Palliative Care. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060838. [PMID: 35740775 PMCID: PMC9221893 DOI: 10.3390/children9060838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/23/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022]
Abstract
Background: Most children needing palliative care (PC) live in low- and middle-income countries. In Colombia, pediatric palliative care (PPC) knowledge among healthcare professionals (HCPs) is lacking as PPC is not included in the educational curricula of healthcare programs. Therefore, specific training that improves knowledge of HCPs and access to PC for children and their families is needed. To address this gap, we organized and conducted the Essential Messages in Palliative Care and Pain Management in Children (EmPalPed), an educational toolkit to increase awareness and promote essential knowledge in PPC for low- and middle-income countries. Methodology: The EmPalPed toolkit consisted of a 5-h virtual workshop with small working groups of HCPs caring for children with life-threatening conditions such as cancer. The toolkit was organized along five key domains: (1) PC as it relates to the concept of quality of life (QoL), (2) effective communication, (3) addressing pain management as a top priority, (4) providing end-of-life care, and (5) access to high-quality PC as a fundamental human right. The workshop activities included different educational strategies and tools (e.g., a pocket guide for pain assessment and management, a PPC booklet, a quick guide for communicating bad news, role playing, and discussions of clinical cases). Results: A total of 145 HCPs from 22 centers were trained. The post-test analysis for HCPs showed that attitude and knowledge about communication (p < 0.001), pain assessment (p < 0.001), first-line opioid of choice in children (p < 0.001), and palliative sedation (p < 0.001) had positive and statistically significant changes from the pre-test analysis. Discussion: This study supported the notion that the EmPalPed educational toolkit is an effective mechanism for raising awareness regarding PPC as well as providing training in many of the key aspects of PPC. The EmPalPed training approach should be studied beyond this setting, and the impact should be measured longitudinally.
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Affiliation(s)
- Ximena García-Quintero
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali 760032, Colombia;
- Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS #260, Memphis, TN 38105, USA; (J.N.B.); (M.M.)
- Correspondence: ; Tel.: +1-(954)-290-1804
| | - Angélica Claros-Hulbert
- Faculty of Health Sciences, Universidad de la Sabana, Chia 250001, Colombia;
- Palliative Care Department, Instituto Nacional de Cancerología, Bogotá 111511, Colombia
| | | | - Jhon Edwar Bolaños-Lopez
- Dirección de Investigación y Desarrollo, Centro de Biociencias, Seguros SURA Colombia, Medellín 050021, Colombia;
| | - María Isabel Cuervo-Suárez
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali 760032, Colombia;
- Faculty of Health Sciences Department, Clinical Medical Science, Universidad Icesi, Cali 760031, Colombia
| | - Martha Gabriela García Durán
- Psycho-Oncology Service, Hospital Pediátrico de Sinaloa “Dr. Rigoberto Aguilar Pico”, Culiacán 80200, Sinaloa, Mexico;
| | - Wendy Gómez-García
- Dr. Robert Reid Cabral Children’s Hospital, Santo Domingo 10107, Dominican Republic;
| | - Michael McNeil
- Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS #260, Memphis, TN 38105, USA; (J.N.B.); (M.M.)
| | - Justin N. Baker
- Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS #260, Memphis, TN 38105, USA; (J.N.B.); (M.M.)
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20
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Peláez Cantero MJ, Morales Asencio JM, Navarro Marchena L, Velázquez González MDR, Sánchez Echàniz J, Rubio Ortega L, Martino Alba R. End of life in patients under the care of paediatric palliative care teams. Multicentre observational study. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 96:394-401. [DOI: 10.1016/j.anpede.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022] Open
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21
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Using Communication Tools to Explore Young Siblings’ Experiences of Having a Brother or Sister with Pediatric Palliative Care Needs. CHILDREN 2022; 9:children9050641. [PMID: 35626818 PMCID: PMC9139212 DOI: 10.3390/children9050641] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 12/30/2022]
Abstract
Siblings of children with palliative care needs often suffer feelings of being neglected, and their needs for information and involvement are frequently unmet. This study aims to explore the experiences and feelings of siblings of children with palliative care needs, and to determine what is important to them. Nine siblings, aged 6–14 years, were interviewed using four different communication tools: See-Hear-Do pictures, including the empty body as a separate element, Bear cards, and words originating from previous sibling research. Data were analyzed using conventional content analysis. Five categories emerged concerning aspects that the siblings described about their situation and things that they found important: being part of a special family; school—a place for leisure, friends, and learning; relentless feelings of guilt and self-blame; losses and separations; and awareness of death—not if, but when. Siblings of children with rare diseases expressed an awareness that their brother or sister would die, although still felt they were part of a special, happy family. Siblings of children with palliative care needs due to an accident described relentless feelings of self-blame and guilt. The needs of siblings may vary depending on the condition that resulted in the ill sibling’s palliative care needs.
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22
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Srivastava R, Srivastava S. Parental Perspective in Paediatric Palliative Care: A Systematic Review of Literature Using the PRISMA Method. Indian J Palliat Care 2022; 28:199-215. [PMID: 35673689 PMCID: PMC9168285 DOI: 10.25259/ijpc_37_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/09/2022] [Indexed: 11/30/2022] Open
Abstract
Research in Parental Perspectives are pivotal in gaining understanding of parents’ experiences, issues, concerns and attitude in pediatric palliative care which affects their decision making. However only a limited number of such studies have included the first-person perspective of Parents. The aim of this article is to understand the contribution of previous research on parental perspectives in pediatric palliative care through a systematic review of literature. Nine articles that met the inclusion criteria were accessed and seven key themes emerged; Psychological perspective, parental concerns, parental needs, parental attitude, spiritual perspective, cultural perspective and financial perspective. This review highlights requirement of more research into parental perspective if possible, covering all key aspects along with additional research in cultural perspective and development of validated tools, checklists and psychometric questionnaires for the assessment of these perspectives in various domains: spiritual, financial, psychological, cultural and social.
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Affiliation(s)
- Rajashree Srivastava
- Department of Psychology, School of Liberal Education, Galgotias University, Greater Noida, Uttar Pradesh, India,
| | - Shikha Srivastava
- Department of Psychology, School of Liberal Education, Galgotias University, Greater Noida, Uttar Pradesh, India,
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23
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The First Step to Initiate Pediatric Palliative Care: Identify Patient Needs and Cooperation of Medical Staff. Healthcare (Basel) 2022; 10:healthcare10010127. [PMID: 35052291 PMCID: PMC8775827 DOI: 10.3390/healthcare10010127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 11/23/2022] Open
Abstract
Few Korean hospitals had experience in pediatric palliative care. Since the beginning of the national palliative care project, interest in pediatric palliative care has gradually increased, but the establishment of professional palliative care is still inadequate due to a lack of indicators. This study aimed to find considerations in the process of initiating palliative care services. The general and clinical characteristics of 181 patients aged less than 24 years who were registered at the pediatric palliative care center from January 2019 to August 2021 were evaluated. Life-limiting condition group 1 had the largest number of patients. The primary need for palliative care was psychological and emotional support, followed by information sharing and help in communication with the medical staff in decision-making processes. Seventy-two patients were technologically dependent, with one to four technical supports for each patient. The registration of patients with cancer increased with time, and the time from disease diagnosis to consultation for pediatric palliative care service was significantly reduced. In conclusion, before starting pediatric palliative care, it is necessary to understand the needs of patients and their families and to cooperate with medical staff.
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24
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Dinkelbach L, Galushko M, Oommen-Halbach A, Felek M, Dechert O, Trocan L, Janßen G. Advance care planning and the parental geographical background in pediatric palliative home care: a retrospective chart review. Eur J Pediatr 2022; 181:2789-2797. [PMID: 35507218 PMCID: PMC9192398 DOI: 10.1007/s00431-022-04469-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/24/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022]
Abstract
The relevance to acknowledge the parental migration history in pediatric palliative care is widely recognized. However, its influence on integral parts of advance care planning (ACP) is unknown. In this non-interventional cohort study, we aimed at identifying systematic differences between pediatric palliative patients with varying parental countries of origin regarding medical orders for life-sustaining treatment and the location of patients' death. Two hundred eighty-eight pediatric cases in an ambulant pediatric palliative care setting in Germany were retrospectively analyzed using multinomial logistic regression models. Agreements on medical orders for life-sustaining treatment (MOLST) differed significantly between patients with varying parental countries of origin. Full code orders for life-sustaining treatment were made more often in Turkish families than in German families. There were no significant associations between the patients' location of death and the parental countries of origin. However, confounder-analysis revealed a strong association between the patients' underlying disease and the orders for life-sustaining treatment as well as the location of death.Conclusions: Even this study indicates that the parental geographical background as an important sociocultural aspect might have an impact on ACP decisions for children and adolescents with life-limiting conditions, other factors as the patients' underlying disease can be more crucial for decision making in pediatric palliative care. The reason for the differences found might lay in cultural preferences or barriers to appropriate care. The inclusion of sociocultural aspects in decision-making is crucial to guarantee culture-sensitive, patient-centered pediatric palliative care.
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Affiliation(s)
- Lars Dinkelbach
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany. .,Centre for Child and Adolescent Health, HELIOS Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Germany.
| | - Maren Galushko
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Anne Oommen-Halbach
- Department of the History, Philosophy and Ethics of Medicine, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Melisa Felek
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Oliver Dechert
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Laura Trocan
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Gisela Janßen
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
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Jarvis S, Flemming K, Richardson G, Fraser L. Adult healthcare is associated with more emergency healthcare for young people with life-limiting conditions. Pediatr Res 2022; 92:1458-1469. [PMID: 35152268 PMCID: PMC9700517 DOI: 10.1038/s41390-022-01975-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/04/2022] [Accepted: 01/24/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Children with life-limiting conditions receive specialist paediatric care in childhood, but the transition to adult care during adolescence. There are concerns about transition, including a lack of continuity in care and that it may lead to increases in emergency hospital visits. METHODS A retrospective cohort was constructed from routinely collected primary and hospital care records for young people aged 12-23 years in England with (i) life-limiting conditions, (ii) diabetes or (iii) no long-term conditions. Transition point was estimated from the data and emergency inpatient admissions and Emergency Department visits per person-year compared for paediatric and adult care using random intercept Poisson regressions. RESULTS Young people with life-limiting conditions had 29% (95% CI: 14-46%) more emergency inpatient admissions and 24% (95% CI: 12-38%) more Emergency Department visits in adult care than in paediatric care. There were no significant differences associated with the transition for young people in the diabetes or no long-term conditions groups. CONCLUSIONS The transition from paediatric to adult healthcare is associated with an increase in emergency hospital visits for young people with life-limiting conditions, but not for young people with diabetes or no long-term conditions. There may be scope to improve the transition for young people with life-limiting conditions. IMPACT There is evidence for increases in emergency hospital visits when young people with life-limiting conditions transition to adult healthcare. These changes are not observed for comparator groups - young people with diabetes and young people with no known long-term conditions, suggesting they are not due to other transitions happening at similar ages. Greater sensitivity to changes at transition is achieved through estimation of the transition point from the data, reducing misclassification bias.
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Affiliation(s)
- Stuart Jarvis
- Martin House Research Centre, University of York, York, UK.
| | - Kate Flemming
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, University of York, York, UK
| | - Gerry Richardson
- grid.5685.e0000 0004 1936 9668Centre for Health Economics, University of York, York, UK
| | - Lorna Fraser
- grid.5685.e0000 0004 1936 9668Martin House Research Centre, University of York, York, UK
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Uzun DD, Lang K, Saur P, Weigand MA, Schmitt FCF. Pediatric cardiopulmonary resuscitation in infant and children with chronic diseases: A simple approach? Front Pediatr 2022; 10:1065585. [PMID: 36467490 PMCID: PMC9714453 DOI: 10.3389/fped.2022.1065585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
Infants and children with complex chronic diseases have lifelong, life-threatening conditions and for many, early death is an unavoidable outcome of their disease process. But not all chronic diseases in children are fatal when treated well. Cardiopulmonary resuscitation is more common in children with chronic diseases than in healthy children. Resuscitation of infants and children presents significant challenges to physicians and healthcare providers. Primarily, these situations occur only rarely and are therefore not only medically demanding but also associated with emotional stress. In case of resuscitation in infants and children with chronic diseases these challenges become much more complex. The worldwide valid Pediatric Advanced Life Support Guidelines do not give clear recommendations how to deal with periarrest situations in chronically ill infants and children. For relevant life-limiting illnesses, a "do not resuscitate" order should be discussed early, taking into account medical, ethical, and emotional considerations. The decision to terminate resuscitative efforts in cardiopulmonary arrest in infants and children with chronic illnesses such as severe lung disease, heart disease, or even incurable cancer is complex and controversial among physicians and parents. Judging the "outcome" of resuscitation as a "good" outcome becomes complex because for some, life extension itself and for others, quality of life is a goal. Physicians often decide that a healthy child is more likely to have a reversible condition and thereby have a better outcome than a child with multiple comorbidities and chronic health care needs. Major challenges in resuscitation infants and children are that clinicians need to individualize resuscitation strategies in light of each chronic disease, anatomy and physiology. This review aims to highlight terms of resuscitation infants and children with complex chronic diseases, considering resuscitation-related factors, parent-related factors, patient-related factors, and physician-related factors.
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Affiliation(s)
- Davut D Uzun
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kristin Lang
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - Patrick Saur
- Department of Pediatric Cardiology and Congenital Heart Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix C F Schmitt
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
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Role of Palliative Care. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00043-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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28
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Chong L, Khalid F, Abdullah A. Compassionate Healthcare for Parents of Children with Life-limiting Illnesses: A Qualitative Study. Indian J Palliat Care 2021; 28:266-271. [PMID: 36072248 PMCID: PMC9443155 DOI: 10.25259/ijpc_50_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/26/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: Premature death of a child from a serious illness is probably one of the most painful experiences for a parent. This study examined the clinical experiences of bereaved parents of children with a life-limiting illness to provide recommendations for quality care. Materials and Methods: Data were collected using semi-structured in-depth interviews with bereaved parents whose children had died at least 3 months before the interview. Parents were purposively sampled from two institutions offering end-of-life care to children with life-limiting illnesses. Data were analysed using thematic analysis. Results: Data analysis revealed three main themes: (1) Clinical communication, (2) Healthcare infrastructure and (3) Non-physical aspects of healthcare. The seven subthemes uncovered were as follows: (1) Honesty and clarity, (2) empathy, (3) interdisciplinary communication, (4) inconveniences in hospital, (5) home palliative care, (6) financial burden of illness and (7) psychosocial and spiritual support. Conclusion: Strategies to improve healthcare for children and their families are multifold. Underlying the provision of quality care is compassion; a child and family-friendly healthcare system with compassionate providers and compassionate institutional policies are vital components to achieving quality healthcare. Culturally sensitive psychosocial, emotional and spiritual support will need to be integrated as standard care.
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Affiliation(s)
- Leeai Chong
- Department of Paediatrics University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan, Malaysia,
| | - Farah Khalid
- Department of Paediatrics University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan, Malaysia,
| | - Adina Abdullah
- Department of Primary Care Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan, Malaysia,
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Kenney AE, Bedoya SZ, Gerhardt CA, Young-Saleme T, Wiener L. End of life communication among caregivers of children with cancer: A qualitative approach to understanding support desired by families. Palliat Support Care 2021; 19:715-722. [PMID: 33641691 PMCID: PMC8408277 DOI: 10.1017/s1478951521000067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Clinicians and parents are encouraged to have open and honest communication about end of life with children with cancer, yet there remains limited research in this area. We examined family communication and preferred forms of support among bereaved caregivers of children with cancer. METHODS Bereaved caregivers were recruited through a closed social media group to complete an online survey providing retrospective reports of end of life communication with their child and preferences for communication support from health-care providers. The sample of 131 participants was mostly female (77.9%; n = 102) with an average age of 49.15 (SD = 8.03) years. Deceased children were of an average age of 12.42 years (SD = 6.01) and nearly 90% of children died within 5 years of diagnosis. RESULTS Most caregivers spoke with their child about their prognosis (61.8%; n = 131) and death (66.7%; n = 99). Half of children (48%; n = 125) asked about death, particularly older children (51.9% ≥12 years; p = 0.03). Asking about dying was related to having conversations about prognosis (p ≤ 0.001) and death (p ≤ 0.001). Most caregivers (71.8%; n = 94) wanted support to talk to their children. Fewer wanted providers to speak to children directly (12.2%; n = 16) or to be present while caregivers spoke to the child (19.8%; n = 26). Several themes emerged from a content analysis of open-ended responses regarding preferences for provider support. SIGNIFICANCE OF RESULTS Most caregivers discussed issues pertaining to end of life irrespective of demographic or medical factors. Qualitative themes provide insight into support desired by families to help with these difficult conversations.
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Affiliation(s)
- Ansley E Kenney
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Sima Zadeh Bedoya
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH
- Department of Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH
| | - Tammi Young-Saleme
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH
- Department of Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH
| | - Lori Wiener
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Archer S, Cheung NH, Williams I, Darzi A. The impact of digital health interventions on the psychological outcomes of patients and families receiving paediatric palliative care: A systematic review and narrative synthesis. Palliat Med 2021; 35:2017-2023. [PMID: 34159851 PMCID: PMC8641035 DOI: 10.1177/02692163211026523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Digital health interventions are becoming increasingly important and may be particularly relevant for paediatric palliative care. In line with the aims of palliative care, digital health interventions should aim to maintain, if not improve, psychological wellbeing. However, the extent to which the psychological outcomes of digital health interventions are assessed is currently unknown. AIM To identify and synthesise the literature exploring the impact of all digital health interventions on the psychological outcomes of patients and families receiving paediatric palliative care. DESIGN Systematic review and narrative synthesis. DATA SOURCES MEDLINE, EMBASE, Health Management Information Consortium, PsycINFO, Cumulative Index to Nursing and Allied Health Literature and the Midwives Information & Resource Service were searched on the 27th July 2020, in addition to the first five pages of Google Scholar. To be included in the review, papers must have contained: quantitative or qualitative data on psychosocial outcomes, data from patients aged 0-18 receiving palliative care or their families, a digital health intervention, and been written in English. RESULTS Three studies were included in the review. All looked at the psychological impact of telehealth interventions. Papers demonstrated fair or good quality reporting but had small sample sizes and varied designs. CONCLUSIONS Despite the design and development of digital health interventions that span the technological landscape, little research has assessed their psychosocial impact in the paediatric palliative care community. Whilst the evidence base around the role of these interventions continues to grow, their impact on children and their families must not be overlooked.
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Affiliation(s)
- Stephanie Archer
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
| | | | - Ivor Williams
- Helix Centre, Imperial College London, St Mary’s Hospital, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
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31
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Porter AS, Weaver MS, Snaman JM, Li C, Lu Z, Baker JN, Kaye EC. "Still Caring for the Family": Condolence Expression Training for Pediatric Residents. J Pain Symptom Manage 2021; 62:1188-1197. [PMID: 34062219 DOI: 10.1016/j.jpainsymman.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Abstract
CONTEXT Insufficient communication from the medical team following a child's death may compound parental grief. Pediatric residents care for children who die, yet the landscape of condolence expression education within residency programs has not been studied. OBJECTIVES The objective of this study was to evaluate pediatric residents' levels of experience and comfort with condolence expression and to assess their needs and desires for training in condolence expression. METHODS A cross-sectional, mixed-methods survey was developed by palliative care clinicians in collaboration with bereaved parents. In 2020, following pilot testing, an electronic survey measuring resident experience with, comfort with, and training on condolence expression was distributed to 202 third-year pediatric residents across 17 Accreditation Council for Graduate Medical Education-accredited programs representing varying sizes and geographic regions. RESULTS Ten percent of pediatric residents surveyed reported having training on condolence expression. Almost all residents considered condolence expression to be beneficial for bereaved families and most for clinicians, too, yet very very few had formally expressed condolences in their roles as physicians: 83.1% had never written a condolence letter; 85% had never made a condolence phone call; and 90.5% had never attended a memorial event. Commonly reported barriers to condolence expression included lack of experience and training, as well as concern about upsetting families. CONCLUSIONS Pediatric residents lack comfort with and training in condolence expression and desire education to address these gaps. These findings should inform development and investigation of educational resources and training opportunities for residents to learn and practice compassionate provision of condolences to grieving families.
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Affiliation(s)
- Amy S Porter
- St. Jude Children's Research Hospital (A.S.P., C.L., Z.L., J.N.B., E.C.K.), Memphis, Tennessee, USA.
| | - Meaghann S Weaver
- Department of Pediatrics, Children's Hospital and Medical Center (M.S.W.), Omaha, Nebraska, USA; National Center for Ethics in Healthcare (M.S.W.), Washington, District of Columbia, USA
| | - Jennifer M Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.M.S.), Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital (J.M.S.), Boston, Massachusetts, USA
| | - Chen Li
- St. Jude Children's Research Hospital (A.S.P., C.L., Z.L., J.N.B., E.C.K.), Memphis, Tennessee, USA
| | - Zhaohua Lu
- St. Jude Children's Research Hospital (A.S.P., C.L., Z.L., J.N.B., E.C.K.), Memphis, Tennessee, USA
| | - Justin N Baker
- St. Jude Children's Research Hospital (A.S.P., C.L., Z.L., J.N.B., E.C.K.), Memphis, Tennessee, USA
| | - Erica C Kaye
- St. Jude Children's Research Hospital (A.S.P., C.L., Z.L., J.N.B., E.C.K.), Memphis, Tennessee, USA
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Grunauer M, Mikesell C, Bustamante G, Aronowitz D, Zambrano K, Icaza-Freire AP, Gavilanes AWD, Barrera R. Availability and Quality of Grief and Bereavement Care in Pediatric Intensive Care Units Around the World, Opportunities for Improvement. Front Pediatr 2021; 9:742916. [PMID: 34869100 PMCID: PMC8634722 DOI: 10.3389/fped.2021.742916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/22/2021] [Indexed: 11/22/2022] Open
Abstract
Pediatric Intensive Care Units (PICUs) provide multidisciplinary care to critically ill children and their families. Grief is present throughout the trajectory of illness and can peak around the time of death or non-death losses. The objective of this study was to assess how PICUs around the world implement grief and bereavement care (GBC) as part of an integrated model of care. This is a multicenter cross-sectional, prospective survey study. Questionnaires with multiple-choice and open-ended questions focusing on unit infrastructure, personnel, policies, limited patient data, and practices related to GBC for families and health care professionals (HCPs) were completed by on-site researchers, who were HCPs on the direct care of patients. PICU fulfillment of GBC goals was evaluated using a custom scoring based on indicators developed by the Initiative for Pediatric Palliative Care (IPPC). We compared average total and individual items fulfillment scores according to the respective country's World Bank income. Patient characteristics and details of unit infrastructure were also evaluated as potential predictors of total GBC fulfillment scores. Statistical analysis included multilevel generalized linear models (GLM) with a Gaussian distribution adjusted by child age/gender and clustering by center, using high income countries (HICs) as the comparative reference. Additionally, we applied principals of content analysis to analyze and summarize open-ended answers to contextualize qualitative data. The study included 34 PICUs from 18 countries: high-income countries (HICs): 32.4%, upper middle-income countries (UMICs): 44.1%, low middle-income and low-income countries (LMI/LICs): 23.5%. All groups reported some compliance with GBC goals; no group reported perfect fulfillment. We found statistically significant differences in GBC fulfillment scores between HICs and UMICs (specifically, HCP grief support), and between HICs and LMICs (specifically, family grief support and HCP grief support). PICUs world-wide provide some GBC, independent of income, but barriers include lack of financial support, time, and training, overall unit culture, presence of a palliative care consultation service, and varying cultural perceptions of child death. Disparities in GBC for families and HCPs exist and were related to the native countries' income level. Identifying barriers to support families and HCPs, can lead to opportunities of improving GBC in PICUs world-wide.
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Affiliation(s)
- Michelle Grunauer
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
- Pediatric Intensive Care Unit, Hospital de los Valles, Quito, Ecuador
| | - Caley Mikesell
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
| | | | - Danielle Aronowitz
- Department of Surgery, Long Island Jewish Medical Center, Northwell/Hofstra University School of Medicine, New Hyde Park, NY, United States
| | - Kevin Zambrano
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
| | | | | | - Rafael Barrera
- Department of Surgery, Long Island Jewish Medical Center, Northwell/Hofstra University School of Medicine, New Hyde Park, NY, United States
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Zarenti M, Kressou E, Panagopoulou Z, Bacopoulou F, Kokka I, Vlachakis D, Chrousos GP, Darviri C. Stress among pediatric oncology staff. A systematic review. EMBNET.JOURNAL 2021; 26:e981. [PMID: 34840964 PMCID: PMC8623911 DOI: 10.14806/ej.26.1.981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cancer is considered one of the dominant life-threatening diseases in children. Working in the field of pediatric oncology, although rewarding, can be a source of stress and emotional burden for health care providers. The aim of this systematic review was to summarise the evidence regarding the occupational stress of health care providers working with pediatric cancer patients. Extensive search of the Pubmed and Scopus databases was performed to identify studies relevant to the topic. Initial search retrieved 657 studies. The reviewing investigators, after applying the inclusion/exclusion criteria, extracted data to critically appraise the quality of evidence. The final step of search concluded in 23 studies of heterogeneous design. Results revealed two main domains of which occupational stress derived from i) the interaction of the health care provider with the patient and the family, and ii) several organisational factors, such as hierarchical structures, experience, workload, and low organisational support. Literature on the stress of pediatric oncology staff is limited. The rather small sample sizes of the studies, the heterogeneity of methodological design, the lack of assessment from a sociological point of view, as well as the limited psychometric instruments adapted to pediatric oncology staff, make the validity of the results questionable. Further research is warranted to obtain a more accurate view of the field, to identify a cause-effect relation between work-related stress and pediatric oncology staff, and, more importantly, to guide future recommendations on support systems and stress management training within pediatric oncology settings.
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Affiliation(s)
- Maria Zarenti
- Postgraduate Course of Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Kressou
- Postgraduate Course of Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Zacharo Panagopoulou
- Postgraduate Course of Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health & Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Ioulia Kokka
- Postgraduate Course of Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vlachakis
- University Research Institute of Maternal and Child Health & Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, Greece
- Lab of Molecular Endocrinology, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - George P Chrousos
- University Research Institute of Maternal and Child Health & Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Christina Darviri
- Postgraduate Course of Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Porter AS, Zalud K, Applegarth J, Woods C, Gattas M, Rutt E, Williams K, Baker JN, Kaye EC. Community Hospice Nurses' Perspectives on Needs, Preferences, and Challenges Related to Caring for Children With Serious Illness. JAMA Netw Open 2021; 4:e2127457. [PMID: 34605916 PMCID: PMC8491107 DOI: 10.1001/jamanetworkopen.2021.27457] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Many of the 50 000 children who die annually are eligible for provision of community-based hospice care, yet few hospice organizations offer formal pediatric services. Population-level data demonstrate that hospice nurses lack training, experience, and comfort in caring for children, but their specific educational needs and preferences are poorly understood. OBJECTIVE To assess the pediatric-specific training and support needs of hospice nurses caring for children in the community. DESIGN, SETTING, AND PARTICIPANTS For this qualitative study, 41 nurses were purposively seletected from a population-level cohort of 551 hospice nurses who completed a previous mixed-methods survey; these 41 nurses participated in semistructured interviews between February and April 2019. Hospice nurses were recruited from all accredited hospice organizations in Tennessee, Mississippi, and Arkansas that offer care to pediatric patients. Content analysis of interview transcripts was conducted. MAIN OUTCOMES AND MEASURES The interview guide probed for topics related to prior pediatric hospice training experiences, desires and preferences for training, and perceived barriers to training. RESULTS Interviews were conducted with 41 nurses representing different geographic regions and levels of comfort with pediatric hospice provision (as self-reported in the prior survey). Thirty-eight of the nurses were women (92.7%), with a median age of 40-49 years (range, 20-29 to ≥60 years) and median tenure of 5-9 years (range, <1 to ≥20 years) as a hospice nurse. Respondents included 1 American Indian or Alaska Native nurse (2.4%), 1 Black nurse (2.4%), and 39 White nurses (95.1%). Across interviews, most hospice nurses reported feeling uncomfortable caring for children with serious illness, and all nurses used language to express the immediacy behind the need for pediatric-specific training and support. Nurses explained why further training and support are needed and clear preferences for who should provide the education, educational modalities, and specific training topics. Nurses also articulated barriers to training and support opportunities and proposed innovative suggestions for overcoming these challenges. Notably, nurses emphasized the need for connection with experts, a sense of community, and solidarity to support frontline clinicians providing end-of-life care to children in the community. CONCLUSIONS AND RELEVANCE In this qualitative study, community hospice nurses expressed an urgent need for improvements in pediatric-specific training opportunities and support, clear preferences for how education should be provided, and recommendations for circumventing barriers to training. These findings are a call to action for the palliative care community to collaborate in rapid implementation of educational programs and networks to systematically support hospice nurses caring for children in the community.
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Affiliation(s)
- Amy S. Porter
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kristina Zalud
- St Louis Children’s Hospital, Washington University School of Medicine, St Louis, Missouri
| | | | - Cameka Woods
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Melanie Gattas
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Emily Rutt
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Karen Williams
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Justin N. Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Erica C. Kaye
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
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Hodgson JM, Douch C, Hartley L, Merve A, Devadass A, Chatterjee F. Problem solving in clinical practice: an unusual cause of multifocal brain lesions. Arch Dis Child Educ Pract Ed 2021; 106:299-303. [PMID: 33087403 DOI: 10.1136/archdischild-2020-319655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | - Ashirwad Merve
- Pathology, Great Ormond Street Hospital for Children, London, UK
| | - Abel Devadass
- Pathology, Great Ormond Street Hospital for Children, London, UK
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Berkmüller M, Gravou-Apostolatou C, Rascher W. [Quality of Pediatric Palliative Care Crisis Intervention - A Retrospective Survey]. KLINISCHE PADIATRIE 2021; 233:286-291. [PMID: 34553364 DOI: 10.1055/a-1589-5854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In addition to palliative care in the dying phase, the care of sick children and their families is becoming increasingly important in times of crisis of a life-limiting illness. The families are supported by a specialised ambulatory palliative team for children and adolescents (SAPV-team for children and adolescents). The aim of the retrospective survey was to determine the quality of these palliative care crisis interventions for the families. METHODOLOGY A retrospective questionnaire on medical care and family burden was developed. The "Hospital Anxiety and Depression Scale" was used to measure the burden of the families, and is aimed to assess anxiety and depression symptoms of the relatives. All families who were cared for by the pediatric palliative care team of the Children's and Adolescent Clinic of the University of Erlangen-Nuremberg in the context of crisis interventions between January 2012 and August 2017 received the questionnaire with the request for cooperation. RESULTS The response rate of the questionnaires was 52,1%. The support and security from the palliative team, the 24-hour on-call service and the support in the organization of medical aids were rated particularly highly. The crisis intervention significantly improved the burden on patients and the family, as well as symptom control and communication. DISCUSSION The present study demonstrates the tremendous psychological and physical stress with reduced quality of life of both sick children and their families in crisis situations. Specialized outpatient pediatric palliative care is able to help patients and families.
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Pediatric palliative care: Competency and educational needs assessment in pediatricians of a developing country. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2021. [DOI: 10.1016/j.phoj.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Basu MR, Partin L, Revette A, Wolfe J, DeCourcey DD. Clinician Identified Barriers and Strategies for Advance Care Planning in Seriously Ill Pediatric Patients. J Pain Symptom Manage 2021; 62:e100-e111. [PMID: 33823242 DOI: 10.1016/j.jpainsymman.2021.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Parents desire more opportunities for advance care planning (ACP), however, large-scale adoption of ACP for seriously ill children remains unrealized. Little is known about current approaches to ACP and strategies to circumvent existing barriers to ACP provision. OBJECTIVE To explore multidisciplinary clinician perceptions about perceived barriers and strategies to improve ACP provision. DESIGN Qualitative study including focus groups conducted with multidisciplinary clinicians at two centers from December 2018-April 2019. Iterative multi-stage thematic analyses were utilized to identify key contexts and themes pertaining to current approaches to ACP, as well as clinician perspectives on ACP barriers and improvement strategies. RESULTS Thirty-five clinicians (physicians, nurses, and psychosocial clinicians) participated in identifying both clinician and perceived patient and family barriers to initiating and engaging in ACP discussions, including mixed messaging, lack of knowledge of patient and family goals, prognostic uncertainty, poor prognostic awareness, unstandardized documentation, and family dynamics. Clinicians also identified strategies to overcome these barriers and to facilitate ACP discussions, including enhancing multidisciplinary communication, creation of a shared ACP communication framework, and formal training in ACP communication to normalize ACP throughout a child's disease trajectory. CONCLUSION Despite ubiquitous recognition of the importance of ACP communication, various clinician- and parent-level barriers were identified which impede ACP in children with serious illness and their families. Improvement strategies should focus on formal clinician training on how to conduct and document longitudinal ACP discussions to ensure care is aligned with family goals and values.
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Affiliation(s)
- Meera R Basu
- Department of Pediatrics, Boston Children's Hospital (M.R.B., L.P., J.W., D.D.D.), Boston, Massachusetts.
| | - Lindsay Partin
- Department of Pediatrics, Boston Children's Hospital (M.R.B., L.P., J.W., D.D.D.), Boston, Massachusetts
| | - Anna Revette
- Survey and Data Management Core, Dana Farber Cancer Institute (A.R.), Boston, Massachusetts
| | - Joanne Wolfe
- Department of Pediatrics, Boston Children's Hospital (M.R.B., L.P., J.W., D.D.D.), Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute (J.W.), Boston, Massachusetts
| | - Danielle D DeCourcey
- Department of Pediatrics, Boston Children's Hospital (M.R.B., L.P., J.W., D.D.D.), Boston, Massachusetts
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Fladeboe KM, O'Donnell MB, Barton KS, Bradford MC, Steineck A, Junkins CC, Yi-Frazier JP, Rosenberg AR. A novel combined resilience and advance care planning intervention for adolescents and young adults with advanced cancer: A feasibility and acceptability cohort study. Cancer 2021; 127:4504-4511. [PMID: 34358332 DOI: 10.1002/cncr.33830] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/03/2021] [Accepted: 07/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Few evidence-based psychosocial programs have been tested among adolescents and young adults (AYAs) with advanced cancer (AC), and early advance care planning (ACP) in this population is rare. The authors aimed to determine the feasibility and acceptability of 1) delivering an established resilience-coaching program, and 2) integrating ACP into that program, among AYAs with AC. METHODS Eligible AYAs were 12 to 24 years old, diagnosed with advanced cancer (recurrent/refractory disease or a diagnosis associated with <50% survival) and fluent in English. The Promoting Resilience in Stress Management-Advanced Cancer (PRISM-AC) program included PRISM's standard sessions targeting stress-management, goal-setting, cognitive-restructuring, and meaning-making, delivered 1:1, 1 to 2 weeks apart, plus a new session involving elements of the AYA-specific Voicing My Choices ACP guide. Participants completed surveys at baseline and 12 weeks, and exit interviews following study completion. Feasibility was defined as ≥70% completion of 1) standard 4-session PRISM and 2) the new ACP session among those completing standard PRISM. Acceptability was defined qualitatively. Trajectories of patient-reported anxiety, depression, and hope were examined descriptively. RESULTS Of 50 eligible, approached AYAs, 26 (52%) enrolled and completed baseline surveys. The AYAs had a mean age of 16 years (SD = 2.7 years), and the majority were male (73%) and White/Caucasian (62%). Twenty-two AYAs (85%) completed standard PRISM, and of those, 18 (82%) completed the ACP session. Feedback was highly positive; 100% and 91% described the overall and ACP programs as valuable, respectively. Anxiety, depression, and hope were unchanged after the program. CONCLUSIONS Resilience coaching followed by integrated ACP is feasible and acceptable for AYAs with AC. Participating did not cause distress or decrease hope. LAY SUMMARY Advance care planning (ACP) among adolescents and young adults (AYAs) with advanced cancer can be difficult to introduce. We investigated whether it is feasible and acceptable to integrate ACP into an existing resilience-coaching program for AYAs. In this cohort study of 26 AYAs with advanced cancer, we found the Promoting Resilience in Stress Management-Advanced Cancer program to be feasible (≥70% intervention-completion) and highly acceptable (positive post-participation feedback, no evidence of participant-distress). We conclude that an intervention integrating resilience coaching and ACP is feasible and acceptable among AYAs with advanced cancer.
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Affiliation(s)
- Kaitlyn M Fladeboe
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
| | - Maeve B O'Donnell
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Krysta S Barton
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Miranda C Bradford
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Children's Core for Biomedical Statistics, Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Angela Steineck
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
| | - Courtney C Junkins
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Abby R Rosenberg
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
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Peláez Cantero MJ, Morales Asencio JM, Navarro Marchena L, Velázquez González MDR, Sánchez Echàniz J, Rubio Ortega L, Martino Alba R. [End of life in patients under the care of paediatric palliative care teams. Multicentre observational study]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00222-8. [PMID: 34303629 DOI: 10.1016/j.anpedi.2021.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Around 2000 children and adolescents die each year in Spain, however, we know little about the particularities of deaths in paediatrics. The purpose of this study is to document the characteristics of patients who die in the care of paediatric palliative care teams in Spain. PATIENTS AND METHODS Retrospective, descriptive, multicentre study. Fourteen teams from all over the country participated. RESULTS Data were obtained from 164 patients. In most cases the underlying disease stemmed from oncological, neurological or neuromuscular processes. The median age at death was 6.9 years (RIC 11.2). The median follow-up time by the team was 0.3 years (RIC 0.8 years). The most frequent symptoms in the last week of life were dyspnoea, pain, increased secretions and sleep disorders. The median number of drugs administered to each patient one week prior to death was 6 (RIC 4). The place of death for 95 of the patients (57.9%) was hospital while 67 (40.9%) died at home. CONCLUSIONS There was a wide age range of patients and they had substantial exposure to polypharmacy. The follow-up time shows that patients have late access to palliative care programmes. An effort should be made to introduce this care earlier rather than relegating it to the end of life. In Spain there is an unequal distribution of resources and not all teams can provide care at home. The place of death should be interpreted with caution.
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Affiliation(s)
- Maria José Peláez Cantero
- Unidad de Crónicos complejos y Cuidados Paliativos pediátricos, Hospital Regional Universitario, Materno-Infantil de Málaga, Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, España.
| | - Jose Miguel Morales Asencio
- Facultad de Ciencias de la Salud, Universidad de Málaga, Instituto de Investigación biomédica de Málaga (IBIMA), Málaga, España
| | - Lucia Navarro Marchena
- Servicio de Atención Paliativa y Paciente Crónico Complejo, Hospital Sant Joan de Déu, Barcelona, España
| | | | - Jesús Sánchez Echàniz
- Equipo de Cuidados Paliativos pediátricos domiciliarios, Hospital Universitario de Cruces, Bilbao, España
| | - Laura Rubio Ortega
- Unidad de hospitalización a domicilio pediatrica, Servicio de Pediatría, Hospital general universitario de Alicante, Alicante, España
| | - Ricardo Martino Alba
- Unidad de Atención Integral Paliativa Pediátrica, Hospital Infantil Universitario Niño Jesús, Madrid, España
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Kim JY, Park BK. The Most Important Aspects for a Good Death: Perspectives from Parents of Children with Cancer. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211028580. [PMID: 34218697 PMCID: PMC8261844 DOI: 10.1177/00469580211028580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A good death is an important concept in pediatric palliative care. To improve the
quality of pediatric palliative care, it is imperative to identify which domain
is most important for a good death among children with cancer and their parents.
This study aimed to (1) assess the essential domains for a good death from the
perspectives of parents whose children have cancer using the Good Death
Inventory (GDI) and (2) examine which characteristics are associated with the
perception of a good death. An anonymous cross-sectional questionnaire was
administered to 109 parents of children with cancer. Data were collected using a
validated Korean version of the GDI. Descriptive statistics,
t-test, and ANOVA were used to identify the preferred GDI
domains. Multiple linear regression analysis was performed to identify factors
associated with the GDI scores. The most essential domains for a good death
included “maintaining hope and pleasure” and “being respected as an individual.”
The factors most strongly associated with the perception of a good death were
end-of-life plan discussion with parents or others and parental agreement with
establishing a living will. Encouraging families to discuss end-of-life care and
establish a living will in advance can improve the quality of death among
children with cancer.
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Affiliation(s)
- Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Bu Kyung Park
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Republic of Korea
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Laronne A, Granek L, Wiener L, Feder-Bubis P, Golan H. Oncologist conceptualizations of pediatric palliative care: challenges and definitions. Support Care Cancer 2021; 29:3981-3989. [PMID: 33392772 PMCID: PMC8164966 DOI: 10.1007/s00520-020-05959-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Pediatric palliative care (PC) is an evolving field and involves a comprehensive approach to care of children with cancer. The goal of this paper was to explore how pediatric oncologists define, interpret, and practice pediatric palliative care in their clinical settings. METHODS The study used the grounded theory approach to data collection and analysis. Twenty-one pediatric oncologists from six pediatric cancer centers across Israel were interviewed. Data was analyzed using line-by-line coding. RESULTS The analysis resulted in a four-tiered conceptual model. This model included the following categories: (1) ill-defined concept; (2) philosophies of palliative care; (3) trajectory of palliative care; and (4) palliative care treatment goals. CONCLUSION The findings illustrate the current conceptualizations of pediatric palliative care among the pediatric oncology community in Israel. The conceptual model documents their understanding of pediatric palliative care as a philosophical approach and the challenges they face in differentiating between palliative care and standard pediatric oncology care. Pediatric palliative care is a highly needed and valued sub-specialty. The findings from this study highlight the importance for its continued development in Israel, as it can reduce the suffering of children and their families. Concurrently, pediatric oncologists need to have more resources and access to explicit knowledge of the conceptual and practical aspects of both primary and specialized pediatric palliative care.
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Affiliation(s)
- Anat Laronne
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B 653, 8410501, Beer Sheva, Israel.
| | - Leeat Granek
- School of Health Policy and Management and Department of Psychology, Faculty of Health, York University, Toronto, Canada
| | - Lori Wiener
- Behavioral Health Core, Psychosocial Support and Research Program, Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Paula Feder-Bubis
- Department of Health Systems Management, Faculty of Health Sciences and Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Hana Golan
- Pediatric Hematology Oncology Department, Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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House TR, Wightman A. Adding Life to Their Years: The Current State of Pediatric Palliative Care in CKD. KIDNEY360 2021; 2:1063-1071. [PMID: 35373080 PMCID: PMC8791371 DOI: 10.34067/kid.0000282021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/05/2021] [Indexed: 01/16/2023]
Abstract
AbstractDespite continued advances in medical treatment, pediatric CKD remains an unremitting, burdensome condition characterized by decreased quality of life and earlier death. These burdens underscore the need for integration of pediatric palliative care (PPC) into nephrology practice. PPC is an evolving field that strives to (1) relieve physical, psychologic, social, practical, and existential suffering; (2) improve quality of life; (3) facilitate decision making; and (4) assist with care coordination in children with life-threatening or life-shortening conditions. Integration of palliative care into routine care has already begun for adults with kidney disease and children with other chronic diseases; however, similar integration has not occurred in pediatric nephrology. This review serves to provide a comprehensive definition of PPC, highlight the unmet need in pediatric nephrology and current integration efforts, discuss the state of palliative care in adult nephrology and analogous chronic pediatric disease states, and introduce future opportunities for study.
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Gagnon M, Kunyk D. Beyond technology, drips, and machines: Moral distress in PICU nurses caring for end-of-life patients. Nurs Inq 2021; 29:e12437. [PMID: 34157180 DOI: 10.1111/nin.12437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
Moral distress is an experience of profound moral compromise with deeply impactful and potentially long-term consequences to the individual. Critical care areas are fraught with ethical issues, and end-of-life care has been associated with numerous incidences of moral distress among nurses. One such area where the dichotomy of life and death seems to be at its sharpest is in the pediatric intensive care unit. The purpose of this study was to understand the moral distress experiences of pediatric intensive care nurses when caring for pediatric patients at the end of life. A secondary analysis was undertaken of seven transcripts from registered nurses across six Canadian pediatric intensive care units and produced three themes: under prioritization of child patient dignity, burden of insider knowledge, and environmental constraints on nursing roles and responsibilities. When caring for patients at the end of life, nurses experienced moral distress when a dignified death was not realized. Furthermore, despite interprofessional collaboration efforts in Canada, the concept of silo mentality persists and contributes to moral distress. Organizational involvement is needed to address moral distress in pediatric intensive care nurses both to achieve a dignified death for child patients and in addressing silo mentality.
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Affiliation(s)
- Michelle Gagnon
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Diane Kunyk
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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45
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Akard TF, Davis K, Hills T, Lense M, Kim D, Webber R, Dietrich MS, Gilmer MJ. Songwriting intervention for cognitively-impaired children with life-limiting conditions: Study protocol. Contemp Clin Trials Commun 2021; 22:100765. [PMID: 33981908 PMCID: PMC8085894 DOI: 10.1016/j.conctc.2021.100765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/11/2021] [Accepted: 03/29/2021] [Indexed: 11/15/2022] Open
Abstract
Investigations evaluating the effectiveness of music-based interventions as a complementary approach to symptom management and health promotion for cognitively-impaired children with life-limiting conditions and their families are needed to minimize the physical and psychological burdens on individuals and their caregivers. Songwriting is one music-based strategy for a remote family-centered complementary approach to improve outcomes for cognitively-impaired children with life-limiting conditions, their parents, and families. The overall purpose of this study is to test the feasibility and preliminary efficacy of a songwriting intervention for cognitively-impaired children (ages 5-17 years) who are receiving palliative or complex care and their parents. Specific aims are to: (1) determine the feasibility of songwriting for cognitively-impaired children with life-limiting conditions and their parents, and (2) examine preliminary efficacy of songwriting for child psychological distress and physical symptoms, parent psychological distress, and family environment. The protocol for this 1-group pre-and post-intervention clinical trial (N = 25) is described.
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Affiliation(s)
| | - Kelly Davis
- Vanderbilt University, Nashville, TN, USA
- Monroe Carrell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Tracy Hills
- Monroe Carrell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Miriam Lense
- Vanderbilt University, Nashville, TN, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dana Kim
- Monroe Carrell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Rylie Webber
- Monroe Carrell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | | | - Mary Jo Gilmer
- Vanderbilt University, Nashville, TN, USA
- Monroe Carrell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
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Song IG, Kwon SY, Chang YJ, Kim MS, Jeong SH, Hahn SM, Han KT, Park SJ, Choi JY. Paediatric palliative screening scale as a useful tool for clinicians' assessment of palliative care needs of pediatric patients: a retrospective cohort study. BMC Palliat Care 2021; 20:73. [PMID: 34030666 PMCID: PMC8146205 DOI: 10.1186/s12904-021-00765-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/07/2021] [Indexed: 11/26/2022] Open
Abstract
Background Although the importance of palliative care in pediatric patients has been emphasized, many health care providers have difficulty determining when patients should be referred to the palliative care team. The Paediatric Palliative Screening Scale (PaPaS) was developed as a tool for screening pediatric patients for palliative care needs. The study aimed to evaluate the PaPaS as a reliable tool for primary care clinicians unfamiliar with palliative care. Methods This was a retrospective cohort study of patients referred to the pediatric palliative care teams in two tertiary hospitals in the Republic of Korea between July 2018 and October 2019. Results The primary clinical and pediatric palliative care teams assessed the PaPaS scores of 109 patients, and both teams reported a good agreement for the sum of the PaPaS score. Furthermore, the PaPaS scores correlated with those obtained using the Lansky performance scale. Although the mean PaPaS score was higher in the pediatric palliative care team, the scores were higher than the cut-off score for referral in both groups. Conclusion The PaPaS can be a useful tool for primary care clinicians to assess the palliative care needs of patients and their families.
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Affiliation(s)
- In Gyu Song
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Republic of Korea.,National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Seung Yeon Kwon
- Palliative Care Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.,Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Yoon Jung Chang
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea.
| | - Min Sun Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Sung Hoon Jeong
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea.,Department of Public Health, Graduate school, Yonsei University, Seoul, Republic of Korea
| | - Seung Min Hahn
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea.,Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Kyu Tae Han
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - So-Jung Park
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Jin Young Choi
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
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47
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Perez A, van der Louw E, Nathan J, El-Ayadi M, Golay H, Korff C, Ansari M, Catsman-Berrevoets C, von Bueren AO. Ketogenic diet treatment in diffuse intrinsic pontine glioma in children: Retrospective analysis of feasibility, safety, and survival data. Cancer Rep (Hoboken) 2021; 4:e1383. [PMID: 33939330 PMCID: PMC8551993 DOI: 10.1002/cnr2.1383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/07/2021] [Accepted: 03/01/2021] [Indexed: 12/23/2022] Open
Abstract
Background Diffuse intrinsic pontine glioma (DIPG) is one of the most devastating diseases among children with cancer, thus novel strategies are urgently needed. Aims We retrospectively evaluated DIPG patients exposed to the carbohydrate restricted ketogenic diet (KD) with regard of feasibility, safety, and overall survival (OS). Methods and results Searches of MEDLINE and Embase identified five hits meeting the search criteria (diagnosis of DIPG and exposure to KD). One additional case was identified by contact with experts. Individual patient data were extracted from publications or obtained from investigators. The inclusion criteria for analysis of the data were defined as DIPG patients who were exposed to the KD for ≥3 months. Feasibility, as described in the literature, was the number of patients able to follow the KD for 3 months out of all DIPG patients identified. OS was estimated by the Kaplan‐Meier method. Five DIPG patients (males, n = 3; median age 4.4 years; range, 2.5‐15 years) meeting the inclusion criteria were identified. Analysis of the available data suggested that the KD is generally relatively well tolerated. Only mild gastro‐intestinal complaints, one borderline hypoglycemia (2.4 mmol/L) and one hyperketosis (max 7.2 mmol/L) were observed. Five out of six DIPG patients identified adhered for ≥3 months (median KD duration, 6.5 months; range, 0.25‐2 years) to the diet. The median OS was 18.7 months. Conclusion Our study provides evidence that it may be feasible for pediatric DIPG patients to adhere for at least 3 months to KD. In particular cases, diet modifications were done. The clinical outcome and OS appear not to be impacted in a negative way. KD might be proposed as adjuvant therapy when large prospective studies have shown feasibility and safety. Future studies might ideally assess the impact of KD on clinical outcome, quality of life, and efficacy.
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Affiliation(s)
- Alexandre Perez
- Cansearch Research Platform for Pediatric Oncology and Hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.,Division of Pediatric Oncology and Hematology, Department of Women, Child and Adolescent, University Hospital of Geneva, Geneva, Switzerland
| | - Elles van der Louw
- Department of Dietetics, Erasmus MC Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands
| | - Janak Nathan
- Department of Neurology, Shushrusha Hospital, Mumbai, India
| | - Moatasem El-Ayadi
- Cansearch Research Platform for Pediatric Oncology and Hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.,Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hadrien Golay
- Division of Pediatric Oncology and Hematology, Department of Women, Child and Adolescent, University Hospital of Geneva, Geneva, Switzerland
| | - Christian Korff
- Department of Pediatrics, Obstetrics and Gynecology, Pediatric Neurology Unit, University Hospital of Geneva, Geneva, Switzerland
| | - Marc Ansari
- Cansearch Research Platform for Pediatric Oncology and Hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.,Division of Pediatric Oncology and Hematology, Department of Women, Child and Adolescent, University Hospital of Geneva, Geneva, Switzerland
| | - Coriene Catsman-Berrevoets
- Department of Pediatric Neurology, Erasmus MC Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands
| | - Andre O von Bueren
- Cansearch Research Platform for Pediatric Oncology and Hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.,Division of Pediatric Oncology and Hematology, Department of Women, Child and Adolescent, University Hospital of Geneva, Geneva, Switzerland
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Variation in Pediatric Palliative Care Allocation Among Critically Ill Children in the United States. Pediatr Crit Care Med 2021; 22:462-473. [PMID: 33116070 DOI: 10.1097/pcc.0000000000002603] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The objectives are as follows: 1) estimate palliative care consult rates and trends among critically ill children and 2) characterize which children receive palliative care consults, including those meeting previously proposed ICU-specific palliative care screening criteria. DESIGN Retrospective cohort. SETTING Fifty-two United States children's hospitals participating in the Pediatric Health Information Systems database. PATIENTS Hospitalized children with nonneonatal ICU admissions from 2007 to 2018. MEASUREMENTS AND MAIN RESULTS The primary outcome was palliative care consultation, as identified by the palliative care International Classification of Disease code. Patient characteristics and outcomes were compared between those with and without palliative care. We used a mixed-effects multivariable model to estimate the independent association between the palliative care and patient characteristics accounting for institution and subject clustering. Hospitalizations were categorized into three mutually exclusive groups for comparative analyses: 1) meeting ICU-specific palliative care criteria, 2) presence of a complex chronic condition not in ICU-specific palliative care criteria, or 3) not meeting ICU-specific palliative care or complex chronic condition criteria. Rates and trends of palliative care consultation were estimated including variation among institutions and variation among subcategories of ICU-specific palliative care criteria. The study cohort included 740,890 subjects with 1,024,666 hospitalizations. About 1.36% of hospitalizations had a palliative care consultation. Palliative care consult was independently associated with older age, female sex, government insurance, inhospital mortality, and ICU-specific palliative care or complex chronic condition criteria. Among the hospitalizations, 30% met ICU-specific palliative care criteria, 40% complex chronic condition criteria, and 30% neither. ICU-specific palliative care patients received more mechanical ventilation and cardiopulmonary resuscitation, had longer hospital and ICU lengths of stay, and had higher inhospital mortality (p < 0.001). Palliative care utilization increased over the study period with considerable variation between the institutions especially in the ICU-specific palliative care cohort and its subgroups. CONCLUSIONS Palliative care consultation for critically ill children in the United States is low. Palliative care utilization is increasing but considerable variation exists across institutions, suggesting inequity in palliative care allocation among this vulnerable population. Future studies should evaluate factors influencing allocation of palliative care among critically ill children in the United States and the drivers of differences between the institutional practices.
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Schuelke T, Crawford C, Kentor R, Eppelheimer H, Chipriano C, Springmeyer K, Shukraft A, Hill M. Current Grief Support in Pediatric Palliative Care. CHILDREN (BASEL, SWITZERLAND) 2021; 8:278. [PMID: 33916583 PMCID: PMC8066285 DOI: 10.3390/children8040278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/27/2021] [Accepted: 04/01/2021] [Indexed: 02/06/2023]
Abstract
Grief support changes as more is learned from current grief theory and research. The authors provide a comprehensive overview of current grief support as it relates to Pediatric Palliative Care (PPC). The following aspects of grief are addressed: (1) anticipatory grief: the nondeath losses that occur with a complex and chronic illness, as well as the time leading up to death; (2) grief around the time of death: the intense and sacred experience of companioning with a dying child; (3) grief after death: supporting bereavement and mourning through programing and other methods; (4) innovative approaches: the future of grief support. The contents of this article are meant to support and educate programs currently providing grief services and those aiming to begin the meaningful work of grief support.
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Affiliation(s)
- Taryn Schuelke
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Claire Crawford
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Rachel Kentor
- Department of Pediatrics, Baylor College of Medicine, Psychology Service, Texas Children’s Hospital, 6701 Fannin St., Houston, TX 77030, USA;
| | - Heather Eppelheimer
- Memorial Hermann Pediatric Hospice, 902 Frostwood Suite 288, Houston, TX 77024, USA;
| | | | - Kirstin Springmeyer
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Allison Shukraft
- Department of Pediatrics, Pediatric Advanced Care Team, Atrium Health’s Levine Children’s Hospital, MEB 415-F, 1000 Blythe Blvd, Charlotte, NC 28203, USA;
| | - Malinda Hill
- Justin Michael Ingerman Center for Palliative Care, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA;
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50
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Lugli L, Garetti E, Rossi K, Torcetta F, Cuomo G, Lucaccioni L, Pugliese M, Bertoncelli N, Rossi C, Riva M, Iughetti L, Ferrari F, Berardi A. La dimissione protetta del bambino clinicamente complesso. MEDICO E BAMBINO 2021; 40:173-179. [DOI: 10.53126/meb40173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Background - In the last few years care for children with severe chronic conditions is a topic of increasing interest. Children with chronic illness often require a high complexity of care and a high level of coordination among health services. Objective - The primary aim of this study is the assessment of children with chronic disease and high complexity of care (children with medical complexity), discharged from the Neonatal Intensive Care Unit (NICU) of Modena University-Hospital. The secondary aim is to assess the outcome of these patients. Methods - Patients with chronic diseases and high complexity of care (children with medical complexity), aged 0-6 months, and admitted to the NICU of Modena in the years 2009-2019 were recruited. Results - 59 subjects were included, of which 15 (25.4%) were born preterm, 11 (18.6%) suffered from hypoxic-ischemic encephalopathy, 33 (56%) had genetic diseases or malformations. All patients were discharged home, except for one patient who was discharged to hospice. The average hospital length of stay was 116.0 ± 63.4 days. Follow-up visits showed that 25 cases (42.4%) remained unchanged, 18 (30.5%) improved and 16 (27.1%) died. Conclusion - This study allows an assessment of patients with early diagnosis of chronic disease with high complexity of care, showing that some of these patients could be eligible for palliative care. The management of children with medical complexity requires diagnostic-therapeutic programmes that focus on them and their families and connect hospital and territorial health services.
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Affiliation(s)
- Licia Lugli
- UOC di Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - Elisabetta Garetti
- UOC di Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - Katia Rossi
- UOC di Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - Francesco Torcetta
- UOC di Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - Giovanna Cuomo
- UOC di Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - Laura Lucaccioni
- UOC di Pediatria, Azienda Ospedaliero-Universitaria Policlinico di M
| | - Marisa Pugliese
- UOC di Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - Natascia Bertoncelli
- UOC di Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - Cecilia Rossi
- UOC di Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - Marika Riva
- UOC di Pediatria, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - Lorenzo Iughetti
- UOC di Pediatria, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - Fabrizio Ferrari
- UOC di Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico di Modena
| | - Alberto Berardi
- UOC di Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico di Modena
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