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Noriega ÍD, García-Salido A, Martino R, Herrero B. Palliative home-based care to pediatric cancer patients: characteristics and healthcare delivered. Support Care Cancer 2021; 30:59-67. [PMID: 34228173 DOI: 10.1007/s00520-021-06412-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cancer patients constitute an important group in pediatric palliative care. Though the patients' home is the preferred place of care, little is known about the characteristics of patients attended by units that provide home assistance. Our objective is to describe the characteristics of cancer patients and healthcare delivered by a pediatric palliative care unit with a home hospitalization program. METHODS Retrospective study based on clinical records of deceased patients attended by the pediatric palliative care unit of Madrid over 10 years. Data collected included general characteristics, type of cancer, whether they received home assistance, place of death, healthcare delivered (hospitalizations, devices, oncological treatments…), and symptom prevalence. RESULTS After excluding 47 patients, the clinical records of 144 patients were analyzed. The median age at referral was 9.4 years (IQR: 5.6-14.1), 61.2% were males; 44.2% had solid non-CNS tumors, 35.4% CNS tumors, and 20.4% hematological malignancies; 137 received home care with 89 not requiring further hospital admissions and 70.1% dying at home. The median follow-up time was 1.6 months (IQR: 0.5-2.9). The most used devices were venous ports (71.4%) and oxygen (49.4%); 53.5% of the patients received oncological support therapies. The most common symptoms were pain (91.8%) dyspnea (49.0%) and fatigue (46.9%). CONCLUSIONS Home assistance was provided in a high number of patients, with a large proportion needing one or no hospital admissions and 70.1% of them dying at home. Further studies characterizing these patients and the factors which promote early access to palliative care are needed.
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Affiliation(s)
- Íñigo de Noriega
- Pediatric Palliative Care Unit, Hospital Infantil Universitario Niño Jesús, Av. Menéndez Pelayo 65, 28009, Madrid (Madrid), Spain.
| | - Alberto García-Salido
- Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid (Madrid), Spain
| | - Ricardo Martino
- Pediatric Palliative Care Unit, Hospital Infantil Universitario Niño Jesús, Av. Menéndez Pelayo 65, 28009, Madrid (Madrid), Spain
| | - Blanca Herrero
- Pediatric Oncology Unit, Hospital Infantil Universitario Niño Jesús, Madrid (Madrid), Spain
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Tutelman PR, Lipak KG, Adewumi A, Fults MZ, Humphrey LM, Gerhardt CA. Concerns of Parents With Children Receiving Home-Based Pediatric Palliative Care. J Pain Symptom Manage 2021; 61:705-712. [PMID: 32931905 DOI: 10.1016/j.jpainsymman.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 01/03/2023]
Abstract
CONTEXT Caring for a child who will die from a life-limiting illness is one of the most difficult experiences a parent may face. Pediatric palliative care (PPC) has grown as a specialty service to address the unique needs of children and families with serious illness. However, gaps remain between the needs of families in PPC and the support received. OBJECTIVES The objective of this study was to explore the concerns of parents who have a child in home-based PPC. METHODS Semistructured interviews were conducted with 25 mothers and 10 fathers from 25 families shortly after their child's referral to home-based PPC. Children (57% male, Mage = 10.5 years, SD = 3.95, range = 4-18 years) had a range of diagnoses. Data were analyzed using inductive content analysis. RESULTS Parents' concerns clustered into four main themes: 1) ensuring that their child's remaining days were spent living well physically, emotionally, and socially; 2) uncertainty regarding their child's diagnosis, prognosis, and treatments; 3) their child's death (e.g., the process of dying and when it will occur); and 4) the family, including the impact of the child's illness and death on siblings and wanting to cherish as much time together with family as possible. CONCLUSION Parents of children receiving home-based PPC expressed concerns across a range of domains, both about their seriously ill child and the broader family. These results highlight salient worries among parents of children in PPC and point to critical areas for intervention for seriously ill children and the broader family.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Keagan G Lipak
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Aminat Adewumi
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Marci Z Fults
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lisa M Humphrey
- Division of Palliative Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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3
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Palliative Care for Children with Lung Diseases. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rosengarten L, Carr E. End-of-life care in paediatrics. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:1114-1117. [PMID: 33104422 DOI: 10.12968/bjon.2020.29.19.1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Leah Rosengarten
- Lecturer, Children's Nursing, Department of Health and Life Sciences, Northumbria University, Newcastle
| | - Elizabeth Carr
- Paediatric Staff Nurse, Paediatrics, Lincoln County Hospital
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Wan A, Weingarten K, Rapoport A. Palliative Care?! But This Child's Not Dying: The Burgeoning Partnership Between Pediatric Cardiology and Palliative Care. Can J Cardiol 2020; 36:1041-1049. [PMID: 32437731 DOI: 10.1016/j.cjca.2020.04.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/16/2020] [Accepted: 04/27/2020] [Indexed: 11/16/2022] Open
Abstract
The field of pediatric cardiology has witnessed major changes over the past few decades that have considerably altered patient outcomes, including decreasing mortality rates for many previously untreatable conditions. Despite this, some pediatric cardiology programs are increasingly choosing to partner with their institutional palliative care teams. Why is this? The field of palliative care also has experienced significant shifts over a similar period of time. Today's palliative care is focused on improving quality of life for any patient with a serious or life-threatening condition, regardless of where they might be on their disease trajectory. Research has clearly demonstrated that improved outcomes can be achieved for a variety of patient cohorts through early integration of palliative care; recent evidence suggests that the same may be true in pediatric cardiology. All pediatric cardiologists need to be aware of what pediatric palliative care has to offer their patients, especially those who are not actively dying. This manuscript reviews the evolution of palliative care and provides a rationale for its integration into the care of children with advanced heart disease. Readers will gain a sense of how and when to introduce palliative care to their families, as well as insight into what pediatric palliative care teams have to offer. Additional research is required to better delineate optimal partnerships between palliative care and pediatric cardiology so that we may promote maximal quality of life for patients concurrently with continued efforts to push the boundaries of quantity of life.
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Affiliation(s)
- Andrea Wan
- Division of Cardiology, Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Kevin Weingarten
- Department of Paediatrics, University of Toronto, Toronto, Canada; Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, Canada
| | - Adam Rapoport
- Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, Canada; Emily's House Children's Hospice, Toronto, Canada; Departments of Paediatrics and Family and Community Medicine, University of Toronto, Toronto, Canada.
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Krivec U, Caggiano S. Noninvasive Ventilation in Palliative Care and Ethical Dilemma. Front Pediatr 2020; 8:483. [PMID: 33014921 PMCID: PMC7493667 DOI: 10.3389/fped.2020.00483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/09/2020] [Indexed: 11/27/2022] Open
Abstract
Significant difference exists between validated indications for noninvasive ventilation (NIV) use in children and current real life practice. Lately, dedicated centers have reported exponential growth of NIV use in children and adolescents. Upper airway obstruction, neuromuscular diseases, chronic lung/thoracic conditions, and central respiratory drive failure remain the most prevalent indications. However, the need to alleviate respiratory failure related distress has been increasingly recognized in several other conditions. Palliative care in children with life limiting disorders is a complex continuum of activities. In order to provide the most appropriate care for the patients and their families, the management often oscillates between actively curative and purely supportive actions. Despite unprecedented therapeutic advancements, several neurologic, metabolic, hemato-oncologic, respiratory, and other rare diseases remain with no curative options. Besides, attentiveness to relive suffering, awareness, and availability have moved the boundaries of NIV use toward conditions formerly not considered suitable for such care. Still, NIV has limitations and can, if sustained in inappropriate circumstances, fail to provide relief. A structured professional frameshift should be available for support and ethical guidance in order to provide confidence to patients, families and all the involved caregivers.
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Affiliation(s)
- Uros Krivec
- Department of Pediatric Pulmology, University Children's Hospital Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Serena Caggiano
- Laboratory Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy
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Oostendorp LJM, Rajapakse D, Kelly P, Crocker J, Dinsdale A, Fraser L, Bluebond-Langner M. Documentation of breakthrough pain in narrative clinical records of children with life-limiting conditions: Feasibility of a retrospective review. J Child Health Care 2019; 23:564-578. [PMID: 30463428 PMCID: PMC7323830 DOI: 10.1177/1367493518807312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study explored the feasibility of generating reliable information on the frequency, nature and management of breakthrough pain (BTP) in children with life-limiting conditions and life-threatening illnesses (LTIs) from narrative clinical records. In the absence of standardized ways for documenting BTP, we conducted a consensus exercise to develop a glossary of terms that could denote BTP in the records. Thirteen clinicians who contributed to the records reached consensus on 45 terms which could denote BTP, while emphasizing the importance of contextual information. The results of this approach together with guidance for improving the reliability of retrospective reviews informed a data extraction instrument. A pilot test of this instrument showed poor agreement between raters. Given the challenges encountered, we do not recommend a retrospective review of BTP using narrative records. This study highlighted challenges of data extraction for complex symptoms such as BTP from narrative clinical records. For both clinical and research purposes, the recording of complex symptoms such as BTP would benefit from clear criteria for applying definitions, a more structured format and the inclusion of validated assessment tools. This study also showed the value of consensus exercises in improving understanding and interpretation of clinical notes within a service.
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Affiliation(s)
- Linda JM Oostendorp
- Louis Dundas Centre for Children’s Palliative Care, UCL Institute of Child Health, University College London, London, UK
| | - Dilini Rajapakse
- Louis Dundas Centre for Oncology Outreach and Children’s Palliative Care, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Paula Kelly
- Louis Dundas Centre for Oncology Outreach and Children’s Palliative Care, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Joanna Crocker
- Louis Dundas Centre for Children’s Palliative Care, UCL Institute of Child Health, University College London, London, UK,Health Experiences Institute, University of Oxford, London, UK
| | - Andrew Dinsdale
- Louis Dundas Centre for Oncology Outreach and Children’s Palliative Care, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lorna Fraser
- Department of Health Sciences, University of York, York, UK
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children’s Palliative Care, UCL Institute of Child Health, University College London, London, UK,Myra Bluebond-Langner, UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, Louis Dundas Centre for Children’s Palliative Care, 30 Guilford Street, London WC1N 1EH, UK.
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Pieper L, Wager J, Zernikow B. Intranasal fentanyl for respiratory distress in children and adolescents with life-limiting conditions. BMC Palliat Care 2018; 17:106. [PMID: 30200942 PMCID: PMC6131941 DOI: 10.1186/s12904-018-0361-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/31/2018] [Indexed: 11/10/2022] Open
Abstract
Background Respiratory distress is one of the most common and frightening symptoms of children with life-limiting conditions. Because treatment of the underlying cause is frequently impossible or insufficient, in many children, symptomatic treatment is warranted. The purpose of this study was to describe the circumstances of the use of intranasal fentanyl in an acute attack of respiratory distress (AARD) in children receiving palliative care, as well as to describe outcomes and adverse events after its use. Methods Children and adolescents treated in a pediatric palliative unit or attended by a specialized home care team between 2010 and 2016 were included in this study. A retrospective chart review was conducted of those who were treated with intranasal fentanyl for an AARD. Results During the study period 16 children (0.5–18.6 years) with various life-limiting conditions were treated with intranasal fentanyl for AARD. In total, 70 AARDs were analyzed. In 74% of all AARDs, a single dose of intranasal fentanyl was used. Frequent causes for an AARD were excessive secretions and acute respiratory infection. The median starting dose of intranasal fentanyl was 1.5 μg/kg body weight. Labored breathing (96%), tachypnea (79%) and related suffering (97%) improved after treatment. An adverse event occurred in one child. Conclusions Intranasal fentanyl may be a safe and effective medication for the treatment of acute attacks of respiratory distress in children with life-limiting conditions. However, prospective studies with larger sample sizes and a control group are needed to validate these findings.
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Affiliation(s)
- Lucas Pieper
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health - School of Medicine, Witten, Germany
| | - Julia Wager
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health - School of Medicine, Witten, Germany.,Paediatric Palliative Care Centre, Children's and Adolescents' Hospital Datteln, Dr.-Friedrich-Steiner-Str.5, 45711, Datteln, Germany
| | - Boris Zernikow
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health - School of Medicine, Witten, Germany. .,Paediatric Palliative Care Centre, Children's and Adolescents' Hospital Datteln, Dr.-Friedrich-Steiner-Str.5, 45711, Datteln, Germany.
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Pieper L, Zernikow B, Drake R, Frosch M, Printz M, Wager J. Dyspnea in Children with Life-Threatening and Life-Limiting Complex Chronic Conditions. J Palliat Med 2018; 21:552-564. [DOI: 10.1089/jpm.2017.0240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lucas Pieper
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health–School of Medicine, Witten/Herdecke University, Datteln, Germany
| | - Boris Zernikow
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health–School of Medicine, Witten/Herdecke University, Datteln, Germany
| | - Ross Drake
- Clinical Lead Paediatric Palliative Care Service, Starship children's Health, Auckland, New Zealand
| | - Michael Frosch
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health–School of Medicine, Witten/Herdecke University, Datteln, Germany
| | - Michael Printz
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health–School of Medicine, Witten/Herdecke University, Datteln, Germany
| | - Julia Wager
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health–School of Medicine, Witten/Herdecke University, Datteln, Germany
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Siden H. Pediatric Palliative Care for Children with Progressive Non-Malignant Diseases. CHILDREN-BASEL 2018; 5:children5020028. [PMID: 29461497 PMCID: PMC5835997 DOI: 10.3390/children5020028] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/04/2018] [Accepted: 02/12/2018] [Indexed: 11/16/2022]
Abstract
A substantial number of children cared for by pediatric palliative care physicians have progressive non-malignant conditions. Some elements of their care overlap with care for children with cancer while other elements, especially prognosis and trajectory, have nuanced differences. This article reviews the population, physical-emotional and social concerns, and trajectory.
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Affiliation(s)
- Harold Siden
- Canuck Place Children's Hospice, BC Children's Hospital, University of British Columbia, Vancouver, BC V6H 3N1, Canada.
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Jamieson L, Wong ICK, Craig F, Christiansen N, Brombley K, Tuleu C, Harrop E. Palliative medicines for children - a new frontier in paediatric research. ACTA ACUST UNITED AC 2016; 69:377-383. [PMID: 27739059 DOI: 10.1111/jphp.12615] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/05/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This paper seeks to highlight from a UK perspective the current lack of a research evidence base in paediatric palliative care that has resulted in a paucity of available medicines with appropriate formulations (strength and dosage form) to provide symptom management for children with life-limiting illnesses and to raise awareness of this group of 'therapeutic orphans'. Currently, clinicians have limited, often unsuitable medication choices for their paediatric palliative care patients, with little hope of moving away from the status quo. KEY FINDINGS Most medicines used in children receiving palliative care are old and off-patent drugs, developed for and tested in an adult population. Many are not available in suitable formulations (dosage form and strength) for administration to children, and there are often no age-related profiles of adverse drug reactions or for safe dosing. SUMMARY Existing regional paediatric palliative care networks and support organisations should lobby funding bodies and the academic community to support appropriate research for this group of therapeutic orphans. Support must also be provided to pharmaceutical companies in the development of suitable products with appropriate formulations.
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Affiliation(s)
| | | | - Finella Craig
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital, UCL Institute of Child Health, London, UK
| | - Nanna Christiansen
- CAG Lead Pharmacist Women and Children & Lead Clinical Pharmacist for Paediatrics, Barts Health NHS Trust, Pathology and Pharmacy Building, London, UK
| | | | | | - Emily Harrop
- Helen & Douglas House Hospices, Oxford, Oxfordshire, UK
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