1
|
García-Fernández J, Romero-García M, Benito-Aracil L, Pilar Delgado-Hito M. Humanisation in paediatric intensive care units: A narrative review. Intensive Crit Care Nurs 2024:103725. [PMID: 38824005 DOI: 10.1016/j.iccn.2024.103725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/02/2024] [Accepted: 05/17/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE To identify findings in the scientific literature relevant to the strategic lines proposed by the Humanising Intensive Care Project in the context of paediatric intensive care units. DESIGN Narrative review. METHODS A literature search was conducted in the databases PubMed, Scopus, CINHAL, and Cochrane Library. Specific indexing terms and search strategies adapted to each database were designed. The inclusion of publications was based on two criteria: 1) related to the paediatric intensive care unit and 2) addresses at least one of the topics related to the strategic lines of the Humanising Intensive Care Project. Study selection was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the quality of the included studies was assessed using the Mixed Method Appraisal tool. RESULTS A total of 100 articles from 19 different countries were included, covering the period between 2019 and 2021. Nineteen different design types were identified. Thirty-two studies were cross-sectional observational studies, while 15 had an experimental approach. The articles were distributed among the seven strategic lines of the Humanising Intensive Care Project. CONCLUSIONS Synthesising the knowledge related to humanisation in paediatric intensive care units will allow progress to be made in improving quality in these units. However, there is disparity in the amount of experimental research overall. IMPLICATIONS FOR CLINICAL PRACTICE There is a disparity in the available research related to the different strategic lines, and it is necessary to carry out more exhaustive research on topics such as the presence and participation of the family in care or the management of post-paediatric intensive care syndrome.
Collapse
Affiliation(s)
- Javier García-Fernández
- Multidisciplinary Nursing Research Group of the Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Marta Romero-García
- Fundamental and Clinical Nursing Department, Faculty of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; GRIN-IDIBELL, Institute of Biomedical Research, L'Hospitalet de Llobregat, Barcelona, Spain; International Research Project for the Humanisation of Health Care, HU-CI Project: Humanising Intensive Care (HU-CI) Project, Collado Villalba, Madrid, Spain.
| | - Llúcia Benito-Aracil
- Fundamental and Clinical Nursing Department, Faculty of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; GRIN-IDIBELL, Institute of Biomedical Research, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mª Pilar Delgado-Hito
- Fundamental and Clinical Nursing Department, Faculty of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; GRIN-IDIBELL, Institute of Biomedical Research, L'Hospitalet de Llobregat, Barcelona, Spain; International Research Project for the Humanisation of Health Care, HU-CI Project: Humanising Intensive Care (HU-CI) Project, Collado Villalba, Madrid, Spain
| |
Collapse
|
2
|
Bernier Carney KM, Goodrich G, Lao A, Tan Z, Kiza AH, Cong X, Hinderer KA. Palliative care referral criteria and application in pediatric illness care: A scoping review. Palliat Med 2023; 37:692-706. [PMID: 36971413 DOI: 10.1177/02692163231163258] [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] [Indexed: 05/30/2023]
Abstract
BACKGROUND Specialty pediatric palliative care services can help to address unmet care needs for children with complex and serious illness. Current guidelines support the identification of unmet palliative care needs; however, it is unknown how these guidelines or other clinical characteristics influence pediatric palliative care referral in research and practice. AIM To evaluate the identification and application of palliative care referral criteria in pediatric illness care and research. DESIGN A scoping review with a content analysis approach to summarize results. DATA SOURCES Five electronic databases (PubMed, CINAHL, PsycINFO, SCOPUS, and Academic Search Premier) were used to identify peer-reviewed literature published in English between January 2010 and September 2021. RESULTS We included 37 articles focused on the referral of pediatric patients to palliative care teams. The identified categories of referral criteria were: disease-related; symptom-related; treatment communication; psychosocial, emotional, and spiritual support; acute care needs; end-of-life care needs; care management needs; and self-referrals for pediatric palliative care services. We identified two validated instruments to facilitate palliative care referral and seven articles which described population-specific interventions to improve palliative care access. Nineteen articles implemented a retrospective health record review approach that consistently identified palliative care needs with varying rates of service use. CONCLUSIONS The literature demonstrates inconsistent methods for identifying and referring children and adolescents with unmet palliative care needs. Prospective cohort studies and clinical trials would inform more consistent pediatric palliative care referral practices. More research is needed on palliative care referral and outcomes in community-focused pediatrics.
Collapse
Affiliation(s)
| | - George Goodrich
- School of Nursing, University of Connecticut, Storrs, CT, USA
| | - Amberly Lao
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Zewen Tan
- School of Medicine, University of Connecticut, Farmington, CT, USA
| | | | - Xiaomei Cong
- School of Nursing, University of Connecticut, Storrs, CT, USA
- School of Nursing, Yale University, Orange, CT, USA
| | - Katherine A Hinderer
- School of Nursing, University of Connecticut, Storrs, CT, USA
- School of Medicine, University of Connecticut, Farmington, CT, USA
- Institute for Nursing Research and Evidence-Based Practice, Connecticut Children's, Hartford, CT, USA
| |
Collapse
|
3
|
Rissman L, Derrington S, Michelson KN. Prognostic Conversations Between Parents and Physicians in the Pediatric Intensive Care Unit. Am J Crit Care 2023; 32:118-126. [PMID: 36854914 DOI: 10.4037/ajcc2023729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Up to 80% of pediatric intensive care unit (PICU) patients experience new morbidities upon discharge. Patients and families rely on clear communication to prepare for post-PICU morbidities. METHODS Surveys were given at PICU discharge to parents and attending physicians of patients who developed multi-organ dysfunction within 24 hours of PICU admission and whose parents completed an initial survey 5 to 10 days after PICU admission. Participants were asked about prognostic conversations regarding PICU mortality; patient post-PICU physical, cognitive, and psychological morbidities; and parent post-PICU psychological morbidities. Parents also indicated whether they wanted more prognostic information. RESULTS Forty-nine parents and 20 PICU attending physicians completed surveys for 49 patients. Thirty parent (61%) and 29 physician (59%) surveys reported participating in any prognostic conversations. Concordance between parents and physicians about prognostic conversations was slight (κ = 0.19). Parent (n = 22; 45%) and physician (n = 23; 47%) surveys most commonly reported prognostic conversations about post-PICU physical morbidities. Parents less commonly reported conversations about post-PICU cognitive morbidities (n = 10; 20%). According to parents, bedside nurses and physicians provided most prognostic information; social workers (54%) most commonly discussed parent psychological morbidities. Twenty-six parents (53%) requested more prognostic information. CONCLUSIONS Most parents and physicians reported having prognostic conversations, primarily about post-PICU physical morbidities. More than half of parents wanted more information about potential post-PICU morbidities. More research is needed to understand how and when medical professionals should have prognostic conversations with parents.
Collapse
Affiliation(s)
- Lauren Rissman
- Lauren Rissman is a pediatric critical care and palliative care physician in the Department of Pediatric Critical Care and Palliative Care, Advocate Children's Hospital, Park Ridge, Illinois
| | - Sabrina Derrington
- Sabrina Derrington is a pediatric critical care physician and bioethicist in the Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, California, and in the Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles
| | - Kelly N Michelson
- Kelly N. Michelson is a pediatric critical care physician and bioethicist in the Division of Pediatric Critical Care, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois, and in the Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago
| |
Collapse
|
4
|
Brock KE, DeGroote NP, Roche A, Lee A, Wasilewski K. The Supportive Care Clinic: A Novel Model of Embedded Pediatric Palliative Oncology Care. J Pain Symptom Manage 2022; 64:287-297.e1. [PMID: 35618251 DOI: 10.1016/j.jpainsymman.2022.05.007] [Citation(s) in RCA: 4] [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: 02/22/2022] [Revised: 05/05/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022]
Abstract
CONTEXT Pediatric palliative care (PPC) improves quality of life and end-of-life outcomes for children with cancer, but often occurs late in the disease course. The Supportive Care Clinic (SCC) was launched in 2017 to expand outpatient PPC access. OBJECTIVES To describe the inaugural four years (2017-2021) of an academic, consultative, embedded SCC within pediatric oncology. METHODS Descriptive statistics (demographic, disease, treatment, visit, and end-of-life) and change over time were calculated. RESULTS During the first four years, 248 patients (51.6% male; 58.1% White; 35.5% Black; 13.7% Hispanic/Latino) were seen in SCC, totaling 1,143 clinic visits (median 4, IQR 2,6), including 248 consultations and 895 follow-up visits. Clinic visits grew nearly 300% from year one to four. Primary diagnoses were central nervous system tumor (41.9%), solid tumor (37.5%), and leukemia/lymphoma (17.3%). The first point of PPC contact became SCC (70.6%) for most referred patients. Among the 136 deceased patients (54.8%), 77.9% had a do-not-resuscitate or Physician Orders for Life Sustaining Treatment in place, and 72.8% received hospice care. When known (n = 112), 89.3% died in their preferred location. The time from SCC consultation to death increased from 74 to 226 days over the four years (P < 0.0001). The proportion of SCC consultations that occurred greater than 90 days from death increased from 39.1% in year one to 85.0% in year four. CONCLUSION Embedded SCC clinics can be successful, achieve steady growth, improve referrals and timing of PPC, and enhance end-of-life care for children with cancer. Large pediatric cancer centers should include SCC outpatient services.
Collapse
Affiliation(s)
- Katharine E Brock
- Aflac Cancer & Blood Disorders Center of Children's Healthcare of Atlanta (K.E.B., N.P.D., A.R., K.W.), Atlanta, Georgia, USA; Department of Pediatrics, Division of Pediatric Hematology/Oncology (K.E.B., K.W.), Emory University. Atlanta, Georgia, USA; Department of Pediatrics, Division of Pediatric Palliative Care (K.E.B.), Emory University, Atlanta, Georgia, USA.
| | - Nicholas P DeGroote
- Aflac Cancer & Blood Disorders Center of Children's Healthcare of Atlanta (K.E.B., N.P.D., A.R., K.W.), Atlanta, Georgia, USA
| | - Anna Roche
- Aflac Cancer & Blood Disorders Center of Children's Healthcare of Atlanta (K.E.B., N.P.D., A.R., K.W.), Atlanta, Georgia, USA
| | - Annika Lee
- Emory University School of Medicine (A.L.), Atlanta, Georgia, USA
| | - Karen Wasilewski
- Aflac Cancer & Blood Disorders Center of Children's Healthcare of Atlanta (K.E.B., N.P.D., A.R., K.W.), Atlanta, Georgia, USA; Department of Pediatrics, Division of Pediatric Hematology/Oncology (K.E.B., K.W.), Emory University. Atlanta, Georgia, USA
| |
Collapse
|
5
|
DURMAZ N, ÖZTELCAN GÜNDÜZ B, ATAS E. Evaluation of the need for hospital-based pediatric palliative care in a single center. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1039048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction/Aim: Cancer is one of the leading causes of death for children . Evidence suggests that these children experience substantial suffering from physical and emotional symptoms. Over the past two decades, paediatric palliative care has emerged as an approach that aims to ease suffering for children and their families coping with any life-threatening illness. Our aim is to encourage the expansion of palliative care centers for children with cancer and integration of these into healthcare services to assist clinicians and policy makers in developing services that address these needs.
Material and Method: Our study is a single-center retrospective cohort study. The records of 39 patients who were followed up in the pediatric oncology clinic between 2010-2021 and died were reviewed retrospectively.
Results: The age of diagnosis of patients was the most in the 6-12 range (n=16; 41%) and the least in the adolescent (n=11; 28.2%) age range. The cause of death was related to a disease in 79.5%. Treatment-related deaths were seen in eight patients, four of which were chemotherapy toxicity, two were engraftment failure in autologous hematopoietic stem cell transplantation, and two were post-transplant GVHD. 76.9% of the patients died in the intensive care unit.
Conclusion: In our study, patients with cancer and those who lost their lives were evaluated retrospectively in terms of symptom load, invasive procedures, and psychosocial needs and the need for end-of-life palliative care. Many studies have confirmed that the timely integration of palliative care into routine oncological care has many advantages, such as improvements in physical and psychological symptoms, quality of life and prognosis, as well as reducing costs. In Turkey, palliative treatment is tried to be provided to late stage pediatric cancer patients by pediatric intensive care units and pediatric oncologists. This both increases the workload of physicians and causes intensive care bed occupation. The development and expansion of palliative care on late stage pediatric cancer patients will contribute significantly to the quality of life of both children and their families.
Collapse
Affiliation(s)
- Nihal DURMAZ
- UNIVERSITY OF HEALTH SCIENCES, GÜLHANE SCHOOL OF MEDICINE, GÜLHANE MEDICINE PR. (ANKARA)
| | - Bahar ÖZTELCAN GÜNDÜZ
- UNIVERSITY OF HEALTH SCIENCES, GÜLHANE SCHOOL OF MEDICINE, GÜLHANE MEDICINE PR. (ANKARA)
| | - Erman ATAS
- UNIVERSITY OF HEALTH SCIENCES, GÜLHANE SCHOOL OF MEDICINE, GÜLHANE MEDICINE PR. (ANKARA)
| |
Collapse
|
6
|
Kern-Goldberger AS, Money NM, Gerber JS, Bonafide CP. Inpatient Subspecialty Consultations: A New Target for High-Value Pediatric Hospital Care? Hosp Pediatr 2021:hpeds.2021-006165. [PMID: 34732510 DOI: 10.1542/hpeds.2021-006165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Nathan M Money
- Division of Pediatric Hospital Medicine, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Jeffrey S Gerber
- Center for Pediatric Clinical Effectiveness
- Division of Infectious Diseases
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher P Bonafide
- Section of Pediatric Hospital Medicine
- Center for Pediatric Clinical Effectiveness
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
7
|
Redefining the Relationship: Palliative Care in Critical Perinatal and Neonatal Cardiac Patients. CHILDREN-BASEL 2021; 8:children8070548. [PMID: 34201973 PMCID: PMC8304963 DOI: 10.3390/children8070548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/24/2021] [Accepted: 06/08/2021] [Indexed: 12/02/2022]
Abstract
Patients with perinatal and neonatal congenital heart disease (CHD) represent a unique population with higher morbidity and mortality compared to other neonatal patient groups. Despite an overall improvement in long-term survival, they often require chronic care of complex medical illnesses after hospital discharge, placing a high burden of responsibility on their families. Emerging literature reflects high levels of depression and anxiety which plague parents, starting as early as the time of prenatal diagnosis. In the current era of the global COVID-19 pandemic, the additive nature of significant stressors for both medical providers and families can have catastrophic consequences on communication and coping. Due to the high prognostic uncertainty of CHD, data suggests that early pediatric palliative care (PC) consultation may improve shared decision-making, communication, and coping, while minimizing unnecessary medical interventions. However, barriers to pediatric PC persist largely due to the perception that PC consultation is indicative of “giving up.” This review serves to highlight the evolving landscape of perinatal and neonatal CHD and the need for earlier and longitudinal integration of pediatric PC in order to provide high-quality, interdisciplinary care to patients and families.
Collapse
|
8
|
Kaye EC, Weaver MS, DeWitt LH, Byers E, Stevens SE, Lukowski J, Shih B, Zalud K, Applegarth J, Wong HN, Baker JN, Ullrich CK. The Impact of Specialty Palliative Care in Pediatric Oncology: A Systematic Review. J Pain Symptom Manage 2021; 61:1060-1079.e2. [PMID: 33348034 PMCID: PMC9896574 DOI: 10.1016/j.jpainsymman.2020.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Children with cancer and their families have complex needs related to symptoms, decision-making, care planning, and psychosocial impact extending across the illness trajectory, which for some includes end of life. Whether specialty pediatric palliative care (SPPC) is associated with improved outcomes for children with cancer and their families is unknown. OBJECTIVE We conducted a systematic review following PRISMA guidelines to investigate outcomes associated with SPPC in pediatric oncology with a focus on intervention delivery, collaboration, and alignment with National Quality Forum domains. METHODS We searched PubMed, Embase, Scopus, Web of Science, and CINAHL databases from inception until April 2020 and reviewed references manually. Eligible articles were published in English, involved pediatric patients aged 0-18 years with cancer, and contained original data regarding patient and family illness and end-of-life experiences, including symptom management, communication, decision-making, quality of life, satisfaction, and healthcare utilization. RESULTS We screened 6682 article abstracts and 82 full-text articles; 32 studies met inclusion criteria, representing 15,635 unique children with cancer and 342 parents. Generally, children with cancer who received SPPC had improved symptom burden, pain control, and quality of life with decreased intensive procedures, increased completion of advance care planning and resuscitation status documentation, and fewer end-of-life intensive care stays with higher likelihood of dying at home. Family impact included satisfaction with SPPC and perception of improved communication. CONCLUSION SPPC may improve illness experiences for children with cancer and their families. Multisite studies utilizing comparative effectiveness approaches and validated metrics may support further advancement of the field.
Collapse
Affiliation(s)
- Erica C Kaye
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
| | - Meaghann S Weaver
- Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Leila Hamzi DeWitt
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Elizabeth Byers
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sarah E Stevens
- Departments of Psychosocial Oncology and Palliative Care and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joe Lukowski
- The University of Nebraska, Omaha, Nebraska, USA
| | - Brandon Shih
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kristina Zalud
- St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jacob Applegarth
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hong-Nei Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, California, USA
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Christina K Ullrich
- Departments of Psychosocial Oncology and Palliative Care and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | | |
Collapse
|
9
|
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.
Collapse
|
10
|
Taylor J, Booth A, Beresford B, Phillips B, Wright K, Fraser L. Specialist paediatric palliative care for children and young people with cancer: A mixed-methods systematic review. Palliat Med 2020; 34:731-775. [PMID: 32362212 PMCID: PMC7243084 DOI: 10.1177/0269216320908490] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Specialist paediatric palliative care services are promoted as an important component of palliative care provision, but there is uncertainty about their role for children with cancer. AIM To examine the impact of specialist paediatric palliative care for children and young people with cancer and explore factors affecting access. DESIGN A mixed-methods systematic review and narrative synthesis (PROSPERO Registration No. CRD42017064874). DATA SOURCES Database (CINAHL, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO) searches (2000-2019) identified primary studies of any design exploring the impact of and/or factors affecting access to specialist paediatric palliative care. Study quality was assessed using The Mixed Methods Appraisal Tool. RESULTS An evidence base of mainly low- and moderate-quality studies (n = 42) shows that accessing specialist paediatric palliative care is associated with less intensive care at the end of life, more advance care planning and fewer in-hospital deaths. Current evidence cannot tell us whether these services improve children's symptom burden or quality of life. Nine studies reporting provider or family views identified uncertainties about what specialist paediatric palliative care offers, concerns about involving a new team, association of palliative care with end of life and indecision about when to introduce palliative care as important barriers to access. There was evidence that children with haematological malignancies are less likely to access these services. CONCLUSION Current evidence suggests that children and young people with cancer receiving specialist palliative care are cared for differently. However, little is understood about children's views, and research is needed to determine whether specialist input improves quality of life.
Collapse
Affiliation(s)
- Johanna Taylor
- Department of Health Sciences, University of York, York, UK
- Martin House Research Centre, University of York, York, UK
| | - Alison Booth
- Department of Health Sciences, University of York, York, UK
- Martin House Research Centre, University of York, York, UK
| | - Bryony Beresford
- Martin House Research Centre, University of York, York, UK
- Social Policy Research Unit, University of York, York, UK
| | - Bob Phillips
- Martin House Research Centre, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lorna Fraser
- Department of Health Sciences, University of York, York, UK
- Martin House Research Centre, University of York, York, UK
| |
Collapse
|
11
|
Rolle der Palliativmedizin in der pädiatrischen Intensivmedizin. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-0732-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|