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Daniels S, Franqui-Rios ND, Mothi SS, Gaitskill E, Cantrell K, Kaye EC. Access to legacy-oriented interventions at end of life for pediatric oncology patients: A decedent cohort review. Pediatr Blood Cancer 2024; 71:e31066. [PMID: 38757484 DOI: 10.1002/pbc.31066] [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: 12/12/2023] [Revised: 04/13/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Legacy-oriented interventions have the potential to offer pediatric oncology patients and families comfort at end of life and during bereavement. Certified child life specialists often provide these services, and presently little is known about whether disparities exist in the provision of legacy-oriented interventions. METHODS In this retrospective decedent cohort study, we examined demographic and clinical characteristics from a sample of 678 pediatric oncology patients who died between 2015 and 2019. Bivariate analysis assessed differences between patients who received any versus no legacy-oriented intervention. Uni- and multivariable logistic regression models assessed associations of baseline characteristics and likelihood of receiving legacy-oriented intervention. Further multivariable analysis explored joint effects of significant variables identified in the univariable analysis. RESULTS Fifty-two percent of patients received a legacy-oriented intervention. Older adolescents (≥13 years) were less likely (odds ratio [OR]: 1.73, p = .007) to receive legacy-oriented interventions than younger ones. Patients with home/hospice deaths were also less likely (OR: 19.98, p < .001) to receive interventions compared to patients who passed away at SJCRH locations. Hispanic patients (OR: 1.53, p = .038) and those in palliative care (OR: 10.51, p < .001) were more likely to receive interventions. No significant race association was noted. CONCLUSION All children and adolescents with cancer deserve quality care at end of life, including access to legacy-oriented interventions, yet nearly half of patients in this cohort did not receive these services. By identifying demographic and clinical characteristics associated with decreased odds of receiving legacy-oriented interventions, healthcare professionals can modify end-of-life care processes to improve access. Introducing legacy-oriented interventions early and increasing exposure in community spaces may enhance access to legacy-oriented interventions for pediatric oncology patients.
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Affiliation(s)
- Sarah Daniels
- Child Life Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Nelson D Franqui-Rios
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico, Puerto Rico
| | - Suraj S Mothi
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Elizabeth Gaitskill
- Child Life Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kathryn Cantrell
- Department of Human Development, Family Studies, and Counseling, Texas Woman's University, Denton, Texas, USA
| | - Erica C Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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2
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Frelinger JM, Tan JM, Klein MJ, Newth CJL, Ross PA, Winter MC. Factors associated with family decision-making after pediatric out-of-hospital cardiac arrest. Resuscitation 2024; 201:110233. [PMID: 38719070 DOI: 10.1016/j.resuscitation.2024.110233] [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: 11/29/2023] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 08/07/2024]
Abstract
AIM This study aims to identify demographic factors, area-based social determinants of health (SDOH), and clinical features associated with medical decision-making after pediatric out-of-hospital cardiac arrest (OHCA). METHODS This is a retrospective, exploratory, descriptive analysis of patients < 18 years old admitted to the pediatric intensive care unit (ICU) after OHCA from 2011 to 2022 (n = 217) at an urban tertiary care, free-standing children's hospital. Outcomes of interest included: (1) whether a new advance care plan (ACP) (defined as a written advance directive including do not resuscitate and/or do not intubate) was ordered during hospitalization, and (2) whether the patient was discharged with new medical technology (defined as tracheostomy and/or feeding tube). Logistic regression models identified features associated with these outcomes. RESULTS Of the 217 patients, 78 patients (36%) had a new ACP placed during their admission. Of the survivors, 26% (27/102) were discharged home with new medical technology. Factors associated with ACP were greater change in Pediatric Cerebral Performance Category (PCPC) score (aOR = 1.49, 95% CI [1.28-1.73], p-value < 0.001) and palliative care consultation (aOR = 2.39, 95% CI [1.16-4.89], p-value 0.018). Factors associated with new medical technology were lower change in PCPC score (aOR = 0.76, 95% C.I. [0.61-0.95], p-value = 0.015) and palliative care consultation (aOR = 7.07, 95% CI [3.01-16.60], p-value < 0.001). There were no associations between area-based SDOH and outcomes. CONCLUSIONS Understanding factors associated with decision-making related to ACP after OHCA is critical to optimize counseling for families. Multi-institutional studies are warranted to identify whether these findings are generalizable.
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Affiliation(s)
- Jessica M Frelinger
- Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA.
| | - Jonathan M Tan
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA; Spatial Sciences Institute, University of Southern California, 3616 Trousdale Parkway, AHF B55, Los Angeles, CA 90089, USA; Department of Anesthesiology, University of Southern California Keck School of Medicine, 1520 San Pablo St., Los Angeles, CA 90033, USA
| | - Margaret J Klein
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA
| | - Christopher J L Newth
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA; Department of Pediatrics, University of Southern California Keck School of Medicine, 1975 Zonal Ave., Los Angeles, CA 90033, USA
| | - Patrick A Ross
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA; Department of Pediatrics, University of Southern California Keck School of Medicine, 1975 Zonal Ave., Los Angeles, CA 90033, USA
| | - Meredith C Winter
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA; Department of Pediatrics, University of Southern California Keck School of Medicine, 1975 Zonal Ave., Los Angeles, CA 90033, USA
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3
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Boyden JY, Umaretiya PJ, D'Souza L, Johnston EE. Disparities in Pediatric Palliative Care: Where Are We and Where Do We Go from Here? J Pediatr 2024; 275:114194. [PMID: 39004168 DOI: 10.1016/j.jpeds.2024.114194] [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: 04/30/2024] [Revised: 06/12/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Affiliation(s)
- Jackelyn Y Boyden
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA; Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Puja J Umaretiya
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Louise D'Souza
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Emily E Johnston
- Institute for Cancer Outcomes and Survivorship, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Pediatric Hematology/Oncology, Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
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Andrist E, Clarke RG, Phelps KB, Dews AL, Rodenbough A, Rose JA, Zurca AD, Lawal N, Maratta C, Slain KN. Understanding Disparities in the Pediatric ICU: A Scoping Review. Pediatrics 2024; 153:e2023063415. [PMID: 38639640 DOI: 10.1542/peds.2023-063415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Health disparities are pervasive in pediatrics. We aimed to describe disparities among patients who are likely to be cared for in the PICU and delineate how sociodemographic data are collected and categorized. METHODS Using MEDLINE as a data source, we identified studies which included an objective to assess sociodemographic disparities among PICU patients in the United States. We created a review rubric, which included methods of sociodemographic data collection and analysis, outcome and exposure variables assessed, and study findings. Two authors reviewed every study. We used the National Institute on Minority Health and Health Disparities Research Framework to organize outcome and exposure variables. RESULTS The 136 studies included used variable methods of sociodemographic data collection and analysis. A total of 30 of 124 studies (24%) assessing racial disparities used self- or parent-identified race. More than half of the studies (52%) dichotomized race as white and "nonwhite" or "other" in some analyses. Socioeconomic status (SES) indicators also varied; only insurance status was used in a majority of studies (72%) evaluating SES. Consistent, although not uniform, disadvantages existed for racial minority populations and patients with indicators of lower SES. The authors of only 1 study evaluated an intervention intended to mitigate health disparities. Requiring a stated objective to evaluate disparities aimed to increase the methodologic rigor of included studies but excluded some available literature. CONCLUSIONS Variable, flawed methodologies diminish our understanding of disparities in the PICU. Meaningfully understanding and addressing health inequity requires refining how we collect, analyze, and interpret relevant data.
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Affiliation(s)
- Erica Andrist
- Division of Pediatric Critical Care Medicine
- Departments of Pediatrics
| | - Rachel G Clarke
- Division of Pediatric Critical Care Medicine, Upstate University Hospital, Syracuse, New York
- Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, New York
| | - Kayla B Phelps
- Division of Pediatric Critical Care Medicine, Louisiana State University Health Sciences Center, Children's Hospital of New Orleans, New Orleans, Louisiana
| | - Alyssa L Dews
- Human Genetics, University of Michigan Medical School, Ann Arbor, Michigan
- Susan B. Meister Child Health and Adolescent Research Center, University of Michigan, Ann Arbor, Michigan
| | - Anna Rodenbough
- Division of Pediatric Critical Care Medicine, Children's Hospital of Atlanta, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Jerri A Rose
- Pediatric Emergency Medicine
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Adrian D Zurca
- Division of Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nurah Lawal
- Stepping Stones Pediatric Palliative Care Program, C.S. Mott Children's Hospital, Ann Arbor, Michigan
- Departments of Pediatrics
| | - Christina Maratta
- Department of Critical Care, The Hospital for Sick Children, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Katherine N Slain
- Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Brumbaugh JE, Bann CM, Bell EF, Travers CP, Vohr BR, McGowan EC, Harmon HM, Carlo WA, Hintz SR, Duncan AF. Social Determinants of Health and Redirection of Care for Infants Born Extremely Preterm. JAMA Pediatr 2024; 178:454-464. [PMID: 38466268 PMCID: PMC10928542 DOI: 10.1001/jamapediatrics.2024.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/17/2024] [Indexed: 03/12/2024]
Abstract
Importance Redirection of care refers to withdrawal, withholding, or limiting escalation of treatment. Whether maternal social determinants of health are associated with redirection of care discussions merits understanding. Objective To examine associations between maternal social determinants of health and redirection of care discussions for infants born extremely preterm. Design, Setting, and Participants This is a retrospective analysis of a prospective cohort of infants born at less than 29 weeks' gestation between April 2011 and December 2020 at 19 National Institute of Child Health and Human Development Neonatal Research Network centers in the US. Follow-up occurred between January 2013 and October 2023. Included infants received active treatment at birth and had mothers who identified as Black or White. Race was limited to Black and White based on service disparities between these groups and limited sample size for other races. Maternal social determinant of health exposures were education level (high school nongraduate or graduate), insurance type (public/none or private), race (Black or White), and ethnicity (Hispanic or non-Hispanic). Main Outcomes and Measures The primary outcome was documented discussion about redirection of infant care. Secondary outcomes included subsequent redirection of care occurrence and, for those born at less than 27 weeks' gestation, death and neurodevelopmental impairment at 22 to 26 months' corrected age. Results Of the 15 629 infants (mean [SD] gestational age, 26 [2] weeks; 7961 [51%] male) from 13 643 mothers, 2324 (15%) had documented redirection of care discussions. In unadjusted comparisons, there was no significant difference in the percentage of infants with redirection of care discussions by race (Black, 1004/6793 [15%]; White, 1320/8836 [15%]) or ethnicity (Hispanic, 291/2105 [14%]; non-Hispanic, 2020/13 408 [15%]). However, after controlling for maternal and neonatal factors, infants whose mothers identified as Black or as Hispanic were less likely to have documented redirection of care discussions than infants whose mothers identified as White (Black vs White adjusted odds ratio [aOR], 0.84; 95% CI, 0.75-0.96) or as non-Hispanic (Hispanic vs non-Hispanic aOR, 0.72; 95% CI, 0.60-0.87). Redirection of care discussion occurrence did not differ by maternal education level or insurance type. Conclusions and Relevance For infants born extremely preterm, redirection of care discussions occurred less often for Black and Hispanic infants than for White and non-Hispanic infants. It is important to explore the possible reasons underlying these differences.
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Affiliation(s)
- Jane E. Brumbaugh
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carla M. Bann
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
| | | | - Colm P. Travers
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Betty R. Vohr
- Department of Pediatrics, Women & Infants Hospital of Rhode Island and Warren Albert Medical School of Brown University, Providence
| | - Elisabeth C. McGowan
- Department of Pediatrics, Women & Infants Hospital of Rhode Island and Warren Albert Medical School of Brown University, Providence
| | | | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Susan R. Hintz
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California
| | - Andrea F. Duncan
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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6
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Park HS, DeGroote NP, Lange A, Kavalieratos D, Brock KE. The Scope of Practice of an Embedded Pediatric Palliative Oncology Clinic. J Pain Symptom Manage 2024; 67:250-259.e5. [PMID: 38065424 DOI: 10.1016/j.jpainsymman.2023.11.030] [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: 10/01/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/22/2023]
Abstract
CONTEXT Pediatric palliative care (PPC) improves end-of-life (EOL) outcomes for children with cancer. Though PPC visits are the 'intervention' in studies focused on EOL care, the content of PPC visits within pediatric oncology is poorly understood. OBJECTIVES This study aimed to understand the scope of PPC practice during visits for children with cancer and their families. METHODS This was a retrospective cohort study of patients 0-27 years with cancer seen in PPC clinic within an academic pediatric oncology center between 2017 and 2022. During each PPC visit, documenting providers chose the domains discussed or managed (goals of care, symptom management, and care coordination with respective subdomains). Data was abstracted from the electronic health record, PPC clinic database, and Cancer Registry. The differences in frequency and addressed domains were analyzed by demographics, visit type, diagnosis group, and proximity to EOL. RESULTS Across 351 patients, 1919 outpatient PPC visits occurred. Median domains were higher in visits <90 days vs. 91+ days from EOL (12.0 vs. 10.0; p < 0.0001); pain and hospice collaboration were particularly discussed closer to EOL. Psychological symptoms like anxiety (30.7% vs. 21.1%; p < 0.001) were addressed more in follow-ups than initial visits. Compared to brain tumor or leukemia/lymphoma visits, solid tumor visits addressed more symptom management subdomains, especially pain (79.9%; p < 0.0001). CONCLUSION The scope of PPC practice is broad and varied. Each visit encompasses many subdomains, the most common being care coordination with oncology teams and helping patients/families cope with the disease. More domains were addressed in solid tumor visits and near EOL.
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Affiliation(s)
- Hee Su Park
- Emory University School of Medicine (H.S.P), Atlanta, Georgia, USA
| | - Nicholas P DeGroote
- Aflac Cancer & Blood Disorders Center (N.P.D, A.L., K.E.B.), Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Anna Lange
- Aflac Cancer & Blood Disorders Center (N.P.D, A.L., K.E.B.), Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine (D.K.), Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Katharine E Brock
- Aflac Cancer & Blood Disorders Center (N.P.D, A.L., K.E.B.), Children's Healthcare of Atlanta, Atlanta, Georgia, USA; Divisions of Pediatric Hematology/Oncology and Palliative Care (K.E.B.), Department of Pediatrics, Emory University, Atlanta, Georgia, USA.
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7
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Buzelli P, Snaman J. "We were made to mourn": A meta-ethnographic synthesis of living through the loss of a child to cancer for Latinx families in the United States. DEATH STUDIES 2023:1-11. [PMID: 38141159 DOI: 10.1080/07481187.2023.2297074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Latinx children with cancer in the United States (US) are more than 50% more likely to die of their cancer compared to non-Latinx White children. Despite this disproportionate likelihood, little is known about the grief experiences of Latinx populations in the US related to the loss of a child including the sociocultural context of this loss experience. We used a meta-ethnographic approach to analyze and synthesize qualitative data across 9 studies related to bereavement and grief in US-based Latinx families following the death of a child. Four key concepts emerged that shape the environment of loss, influence the experience of grief, and affect the related resiliency capacities of Latinx families in the US: (1) immigration context, (2) Latinx cultural influences, (3) social support/familismo, and (4) healthcare inequities. These findings can inform future research and the development of culturally responsive interventions.
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Affiliation(s)
- Patricia Buzelli
- Nursing, Duke University School of Nursing, Durham, North Carolina, USA
| | - Jennifer Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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8
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Sohail AH, Brite J, Khan A, Ye IB, Sohail S, Kilani Y, Ali H, Goyal A. Racial end-of-life care disparities in paediatric gastrointestinal malignancies in the USA. BMJ Support Palliat Care 2023:spcare-2023-004741. [PMID: 38123313 DOI: 10.1136/spcare-2023-004741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Affiliation(s)
| | - Jasmine Brite
- NYU Long Island School of Medicine, Mineola, New York, USA
| | | | - Ivan B Ye
- NYU Langone Hospital - Long Island, Mineola, New York, USA
| | | | | | - Hassam Ali
- East Carolina University, Greenville, South Carolina, USA
| | - Aman Goyal
- Seth GS Medical College and KEM Hospital, Mumbai, India
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9
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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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10
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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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Boyden JY, Bogetz JF, Johnston EE, Thienprayoon R, Williams CSP, McNeil MJ, Patneaude A, Widger KA, Rosenberg AR, Ananth P. Measuring Pediatric Palliative Care Quality: Challenges and Opportunities. J Pain Symptom Manage 2023; 65:e483-e495. [PMID: 36736860 PMCID: PMC10106436 DOI: 10.1016/j.jpainsymman.2023.01.021] [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: 12/05/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
Pediatric palliative care (PPC) programs vary widely in structure, staffing, funding, and patient census, resulting in inconsistency in service provision. Improving the quality of palliative care for children living with serious illness and their families requires measuring care quality, ensuring that quality measurement is embedded into day-to-day clinical practice, and aligning quality measurement with healthcare policy priorities. Yet, numerous challenges exist in measuring PPC quality. This paper provides an overview of PPC quality measurement, including challenges, current initiatives, and future opportunities. While important strides toward addressing quality measurement challenges in PPC have been made, including ongoing quality measurement initiatives like the Cambia Metrics Project, the PPC What Matters Most study, and collaborative learning networks, more work remains. Providing high-quality PPC to all children and families will require a multi-pronged approach. In this paper, we suggest several strategies for advancing high-quality PPC, which includes 1) considering how and by whom success is defined, 2) evaluating, adapting, and developing PPC measures, including those that address care disparities within PPC for historically marginalized and excluded communities, 3) improving the infrastructure with which to routinely and prospectively measure, monitor, and report clinical and administrative quality measures, 4) increasing endorsement of PPC quality measures by prominent quality organizations to facilitate accountability and possible reimbursement, and 5) integrating PPC-specific quality measures into the administrative, funding, and policy landscape of pediatric healthcare.
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Affiliation(s)
- Jackelyn Y Boyden
- Department of Family and Community Health, School of Nursing (J.Y.B.), University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Jori F Bogetz
- Department of Pediatrics, Division of Bioethics and Palliative Care (J.F.B.), University of Washington School of Medicine, Seattle, Washington, USA; Center for Clinical and Translational Research (J.F.B.), Seattle Children's Research Institute, Seattle, Washington, USA
| | - Emily E Johnston
- Department of Pediatrics, Division of Hematology and Oncology (E.E.J.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham (E.E.J.), Birmingham, Alabama, USA
| | - Rachel Thienprayoon
- Department of Anesthesia, Division of Palliative Care, Cincinnati Children's Hospital Medical Center (R.T.), Cincinnati, Ohio, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center (R.T.), Cincinnati, Ohio, USA
| | - Conrad S P Williams
- Palliative Care Program and Department of Pediatrics (C.S.P.W.), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael J McNeil
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine (M.J.M.), Memphis, Tennessee, USA; St. Jude Children's Research Hospital, Division of Quality and Life and Palliative Care, Department of Oncology (M.J.M.), Memphis, Tennessee, USA
| | - Arika Patneaude
- Bioethics and Palliative Care, Seattle Children's Hospital (A.P.), Seattle, Washington, USA; University of Washington School of Social Work (A.P.), Seattle, Washington, USA; Treuman Katz Center for Pediatric Bioethics (A.P.), Seattle, Washington, USA
| | - Kimberley A Widger
- Lawrence S. Bloomberg Faculty of Nursing (K.A.W.), University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children (K.A.W.), Toronto, Ontario, Canada
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care (A.R.S.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School (A.R.S.), Boston, Massachusetts, USA
| | - Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine (P.A.), New Haven, Connecticut, USA; Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center (P.A.), New Haven, Connecticut, USA
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12
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Harmon A, Jordan M, Platt A, Wilson J, Keith K, Chandrashekaran S, Schlichte L, Pendergast J, Ming D. Goal-Concordance in Children with Complex Chronic Conditions. J Pediatr 2023; 253:278-285.e4. [PMID: 36257348 DOI: 10.1016/j.jpeds.2022.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 10/01/2022] [Accepted: 10/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To characterize delivery of goal-concordant end-of-life (EOL) care among children with complex chronic conditions and to determine factors associated with goal-concordance. STUDY DESIGN This was a retrospective review of goals of care discussions for 272 children with at least 1 complex chronic condition who died at a tertiary care hospital between January 1, 2014, and December 31, 2017. Goals of care and code status were assessed before and within the last 72 hours of life. Goals of care discussions were coded as full interventions; considering withdrawal of interventions (palliation); planned transition to palliation; or actively transitioning/transitioned to palliation. RESULTS In total, 158 children had documented goals of care discussions before and within the last 72 hours of life, 18 had goals of care discussions only >72 hours before death, 54 only in the last 72 hours of life, and 42 had no documented goals of care. For children with goals of care, EOL care was goal-concordant for 82.2%, discordant in 7%, and unclear in 10.8%. Black children had a greater than 8-fold greater odds of discordant care compared with White children (OR 8.34, P = .007). Comparison of goals of care and code status before and within the last 72 hours of life revealed trends toward nonescalation of care. Specifically, rates of active palliation increased from 11.7% to 63.0%, and code status shifted from 32.6% do not resuscitate to 65.2% (P < .001). CONCLUSIONS In this cohort, a majority of children had documented goals of care discussions and received goal-concordant EOL care. However, Black children had greater odds of receiving goal-discordant care. Goals of care and code status shifted toward palliation during the last 72 hours of life.
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Affiliation(s)
- Alexis Harmon
- Department of Pediatrics, McGaw Medical Center of Northwestern University, Chicago, IL
| | - Megan Jordan
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Alyssa Platt
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Jonathon Wilson
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Kevin Keith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | | | | | - Jane Pendergast
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - David Ming
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC.
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13
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Grier K, Koch A, Docherty S. Pediatric Goals of Care Communication: A Socioecological Model to Guide Conversations. J Hosp Palliat Nurs 2023; 25:E24-E30. [PMID: 36622315 DOI: 10.1097/njh.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The purpose of this article is to explore factors that influence pediatric patients and their parents during provider-led goals-of-care conversations. Our framework can help providers enhance holistic communication by approaching difficult topics (ie, quality of life, end of life) with an understanding of the multilayered external influences that affect patient/parent decision making. A 5-layer model is presented that describes facilitators to conversations about quality goals of care and advance directives. Each year, complex health conditions (a) affect approximately 500 000 children in the United States, 8600 of whom meet current palliative care criteria, and (b) account for over 7 million child deaths globally. Nurses can use knowledge of the unique values and culture of families with children who have complex health conditions to support them by providing high quality, ongoing goals-of-care conversations, especially if their access to pediatric palliative care is limited.
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14
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Nguyen LB, Vu LG, Nguyen XT, Do AL, Nguyen CT, Boyer L, Auquier P, Fond G, Latkin CA, Ho RCM, Ho CSH. Global Mapping of Interventions to Improve Quality of Life of Patients with Cancer: A Protocol for Literature Mining and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16155. [PMID: 36498229 PMCID: PMC9739766 DOI: 10.3390/ijerph192316155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Cancer led to nearly 10 million deaths in 2020, as reported by the World Health Organization (WHO). Consequently, both biomedical therapeutics and psychological interventions have been implemented to decrease the burden of this non-communicable disease. However, the research conducted so far has only described some aspects of these interventions, which may increase the health-related quality of life of cancer patients. Therefore, a systematic review is necessary to depict an overall picture of the cancer interventions globally. Then, the impact of these interventions on the preference-based health-related quality of life of cancer patients may be synthesized. The protocol is developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Web of Science database is used to retrieve the literature using four keyword terms: quality of life (QoL), cancer, interventions, and health utility. Then, we draw the global mapping diagram and conduct the meta-analysis for this research. Additionally, longitudinal measurements are used to estimate the changes in the health utility of patients during the interventions. Thus, this systematic review can provide insight into the impact of interventions on increasing the health-related quality of life (HRQL) of cancer patients.
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Affiliation(s)
- Long Bao Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Linh Gia Vu
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
| | | | - Anh Linh Do
- Institute of Health Economics and Technology (iHEAT), Hanoi 100000, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
| | - Laurent Boyer
- EA 3279, CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille University, 27, Boulevard Jean-Moulin, CEDEX 05, 13385 Marseille, France
| | - Pascal Auquier
- EA 3279, CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille University, 27, Boulevard Jean-Moulin, CEDEX 05, 13385 Marseille, France
| | - Guillaume Fond
- EA 3279, CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille University, 27, Boulevard Jean-Moulin, CEDEX 05, 13385 Marseille, France
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
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15
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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.
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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
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16
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Kara M, Foster S, Cantrell K. Racial Disparities in the Provision of Pediatric Psychosocial End-of-Life Services: A Systematic Review. J Palliat Med 2022; 25:1510-1517. [PMID: 35588290 DOI: 10.1089/jpm.2021.0476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: When compared with White patients, racial and ethnic minorities experience greater barriers to quality end-of-life care. Each year, approximately 52,000 children die in the United States, yet little is known about the disparities in pediatric palliative care, especially when looking at psychosocial palliative care services such as those provided by child life specialists, social workers, and pediatric psychologists. Objectives: In an effort to consolidate and synthesize the literature on this topic for psychosocial professionals working with children and families confronting a life-threatening diagnosis, a review was conducted. Design: This work was a systematic review of several academic databases that were searched from January 2000 to December 2020 for studies exploring disparities in pediatric end-of-life services and written in English. Setting/Subjects: This review was conducted in the United States. The search yielded 109 articles, of which 16 were included for review. Measurements: Three psychosocial researchers independently reviewed, critically appraised, and synthesized the results. Results: Emerging themes from the literature (n = 16) include service enrollment, decision making, and communication. Results highlight a lack of research discussing psychosocial variables and the provision of psychosocial services. Despite this gap, authors were able to extract recommendations relevant to psychosocial providers from the medical-heavy literature. Conclusions: Recommendations call for more research specific to possible disparities in psychosocial care as this is vital to support families of all backgrounds who are confronting the difficulties of pediatric loss.
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Affiliation(s)
- Mashal Kara
- Department of Human Development, Family Studies, and Counseling, Texas Woman's University, Denton, Texas, USA
| | - Sarah Foster
- Eliot-Pearson Department of Human Development and Child Studies, Tufts University, Medford, Massachusetts, USA
| | - Kathryn Cantrell
- Department of Human Development, Family Studies, and Counseling, Texas Woman's University, Denton, Texas, USA
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17
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Linebarger JS, Johnson V, Boss RD, Linebarger JS, Collura CA, Humphrey LM, Miller EG, Williams CSP, Rholl E, Ajayi T, Lord B, McCarty CL. Guidance for Pediatric End-of-Life Care. Pediatrics 2022; 149:186860. [PMID: 35490287 DOI: 10.1542/peds.2022-057011] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The final hours, days, and weeks in the life of a child or adolescent with serious illness are stressful for families, pediatricians, and other pediatric caregivers. This clinical report reviews essential elements of pediatric care for these patients and their families, establishing end-of-life care goals, anticipatory counseling about the dying process (expected signs or symptoms, code status, desired location of death), and engagement with palliative and hospice resources. This report also outlines postmortem tasks for the pediatric team, including staff debriefing and bereavement.
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Affiliation(s)
- Jennifer S Linebarger
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City, School of Medicine, Kansas City, Missouri
| | - Victoria Johnson
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Renee D Boss
- Department of Pediatrics, Johns Hopkins University School of Medicine, Berman Institute of Bioethics, Baltimore, Maryland
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18
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Ekberg S, Bowers A, Bradford N, Ekberg K, Rolfe M, Elvidge N, Cook R, Roberts SJ, Howard C, Agar M, Deleuil R, Fleming S, Hynson J, Jolly A, Heywood M, Waring S, Rice T, Vickery A. Enhancing paediatric palliative care: A rapid review to inform continued development of care for children with life-limiting conditions. J Paediatr Child Health 2022; 58:232-237. [PMID: 34904760 DOI: 10.1111/jpc.15851] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/19/2021] [Accepted: 11/24/2021] [Indexed: 11/27/2022]
Abstract
AIM Following the establishment of paediatric palliative care services over recent decades, this study sought to identify information to inform future policy and practice. METHODS A rapid review using thematic synthesis was conducted to synthesise existing information about improving paediatric palliative care. Information was extracted in relation to key areas for investment and change: quality, access, advance care planning, skills, research, collaboration and community awareness. RESULTS A total of 2228 literature sources were screened, with 369 included. Synthesised information identified clear ways to improve quality of care, access to care, advance care planning, and research and data collection. The synthesis identified knowledge gaps in understanding how to improve skills in paediatric palliative care, collaboration across Australian jurisdictions and community awareness. CONCLUSIONS The findings of this review bring together information from a vast range of sources to provide action-oriented information to target investment and change in paediatric palliative care over the coming decades.
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Affiliation(s)
- Stuart Ekberg
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Alison Bowers
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Katie Ekberg
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Melanie Rolfe
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Norah Elvidge
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Rebecca Cook
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Sara-Jane Roberts
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,IMPACCT (Improving Palliative Aged and Chronic Care through Clinical Research and Translation) Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Christine Howard
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Meera Agar
- IMPACCT (Improving Palliative Aged and Chronic Care through Clinical Research and Translation) Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Renee Deleuil
- WA Paediatric Palliative Care Service, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Sara Fleming
- Paediatric Palliative Care Service, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Jenny Hynson
- Victorian Paediatric Palliative Care Program, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Ashka Jolly
- Paediatric Palliative Care Service, Centenary Hospital for Women and Children, Garran, Australian Capital Territory, Australia
| | - Melissa Heywood
- Victorian Paediatric Palliative Care Program, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Simon Waring
- Palliative Care Australia, Griffith, Australian Capital Territory, Australia
| | - Toni Rice
- Palliative Care Australia, Griffith, Australian Capital Territory, Australia
| | - Annette Vickery
- Palliative Care Australia, Griffith, Australian Capital Territory, Australia
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19
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Uber A, Ebelhar JS, Lanzel AF, Roche A, Vidal-Anaya V, Brock KE. Palliative Care in Pediatric Oncology and Hematopoietic Stem Cell Transplantation. Curr Oncol Rep 2022; 24:161-174. [DOI: 10.1007/s11912-021-01174-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/18/2022]
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20
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Raybin JL, Hendricks-Ferguson V, Cook P, Jankowski C. Associations between demographics and quality of life in children in the first year of cancer treatment. Pediatr Blood Cancer 2021; 68:e29388. [PMID: 34626456 DOI: 10.1002/pbc.29388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/05/2022]
Abstract
Symptom distress and decreased quality of life (QOL) among children with cancer are well documented. Research is emerging on the child's voice in QOL-symptom reports, but existing QOL questionnaires are burdensome and objective biologic markers are lacking. We examined children's symptoms and QOL from parent and child perspectives and compared the results to one biologic marker (body posture). A cross-sectional secondary analysis of prospective data from children receiving creative arts therapy explored potential associations among demographics with and between QOL measures (PedsQL, Faces Scale, posture). Children (n = 98) ranged in age from 3 to 17 years (M = 7.8) and were in the first year of cancer treatment. No significant associations were found among the child's sex, race/ethnicity, socioeconomic status (SES), or distance from hospital, and total PedsQL. Older age was associated with worse total PedsQL, pain, nausea, worry, and posture (all P < 0.05). Greater worry (β = 0.51) and worse posture (β = 0.41) were the QOL variables most strongly correlated with older age. Poorer posture was associated with worse child PedsQL (total score, nausea, treatment anxiety, cognitive) and parent PedsQL (pain, nausea). Worse scores on the Faces Scale, PedsQL, and posture were all correlated (r = 0.21-0.39, all P < 0.05). Interventions to improve QOL could target nausea, worry, and older patients. Accuracy and interpretation of symptom distress in children are problematic. The Faces Scale and posture may be suitable, readily obtained measures of QOL in pediatric oncology that hold promise.
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Affiliation(s)
- Jennifer L Raybin
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colorado.,University of Colorado Anschutz Medical Campus, College of Nursing and School of Medicine, Aurora, Colorado
| | | | - Paul Cook
- University of Colorado Anschutz Medical Campus, College of Nursing and School of Medicine, Aurora, Colorado
| | - Catherine Jankowski
- University of Colorado Anschutz Medical Campus, College of Nursing and School of Medicine, Aurora, Colorado
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21
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Davis ES, Martinez I, Hurst G, Bhatia S, Johnston EE. Early palliative care is associated with less intense care in children dying with cancer in Alabama: A retrospective, single-site study. Cancer 2021; 128:391-400. [PMID: 34614197 DOI: 10.1002/cncr.33935] [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: 12/09/2020] [Revised: 08/11/2021] [Accepted: 08/30/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Regional studies show that children with cancer receive medically intense end-of-life (EOL) care, but EOL care patterns, including palliative care utilization in Alabama, remain unknown. METHODS This was a retrospective study of 233 children (0-19 years) who received cancer-directed therapy at Children's of Alabama and died from 2010 through 2019. Rates and disparities in palliative care utilization and the association between palliative care and intense EOL care, death location, and hospice were examined. RESULTS The median death age was 11 years; 62% were non-Hispanic White. Forty-one percent had a non-central nervous system (CNS) solid tumor. Fifty-eight percent received palliative care, and 36% received early palliative care (≥30 days before death). Children without relapsed/refractory disease were less likely to receive palliative care than those who had relapsed/refractory disease (adjusted odds ratio [aOR], 0.2; 95% confidence interval [CI], 0.1-0.7). Children with CNS tumors and hematologic malignancies were less likely to have early palliative care (aOR for CNS tumors, 0.4; 95% CI, 0.2-0.7; aOR for hematologic malignancies, 0.3; 95% CI, 0.2-0.7) than children with non-CNS solid tumors. Late palliative care (vs none) was associated with more medically intense care (aOR, 3.3; 95% CI, 1.4-7.8) and hospital death (aOR, 4.8; 95% CI, 1.9-11.6). Early palliative care (vs none) was associated with more hospice enrollment (aOR, 3.4; 95% CI, 1.5-7.6) but not medically intense care (aOR, 1.3; 95% CI, 0.6-2.9) or hospital death (aOR, 1.8; 95% CI, 0.8-3.7). CONCLUSIONS Fifty-eight percent of children dying of cancer in Alabama receive palliative care, but EOL care varies with the receipt and timing (early vs late) of palliative care. Whether this variation reflects differences in child and family preferences or systemic factors (eg, hospice access) remains unknown.
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Affiliation(s)
- Elizabeth S Davis
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Isaac Martinez
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Garrett Hurst
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Emily E Johnston
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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22
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DeGroote NP, Allen KE, Falk EE, Velozzi-Averhoff C, Wasilewski-Masker K, Johnson K, Brock KE. Relationship of race and ethnicity on access, timing, and disparities in pediatric palliative care for children with cancer. Support Care Cancer 2021; 30:923-930. [PMID: 34409499 DOI: 10.1007/s00520-021-06500-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Pediatric palliative care (PPC) improves quality of life for children and adolescents with cancer. Little is known about disparities between different racial and ethnic groups in the frequency and timing of PPC referrals. We evaluated the impact of race and ethnicity on the frequency and timing of PPC referral after initiation of an embedded PPO clinic where no formal consultation triggers exist. METHODS Patients with cancer between 0 and 25 years at diagnosis who experienced a high-risk event between July 2015 and June 2018 were eligible. Demographic, disease, and PPC information were obtained. Descriptive statistics and logistic regression were used to assess likelihood of receiving PPC services by race/ethnicity. RESULTS Of 426 patients who experienced a high-risk event, 48% were non-Hispanic White, 31% were non-Hispanic Black, 15% were Hispanic of any race, and 4% were non-Hispanic Asian. No significant differences were found between race/ethnicity and age at diagnosis/death, sex, and diagnosis. PPC consultation (p = 0.03) differed by race. Non-Hispanic Black patients were 1.7 times more likely than non-Hispanic White patients to receive PPC after adjustment (p = 0.01). White patients spent less days in the hospital in the last 90 days of life (3.0 days) compared with Black (8.0), Asian (12.5), or Hispanic patients (14.0, p = 0.009) CONCLUSION: Disparities exist in patients receiving pediatric oncology and PPC services. Cultural tendencies as well as unconscious and cultural biases may affect PPC referral by race and ethnicity. Better understanding of cultural tendencies and biases may improve end-of-life outcomes for children and young adults with cancer.
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Affiliation(s)
- Nicholas P DeGroote
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kristen E Allen
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Erin E Falk
- Department of Emergency Medicine, Columbia University, New York, NY, USA
| | | | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University, 2015 Uppergate Drive, HSRB W-352, Atlanta, GA, 30322, USA
| | - Khaliah Johnson
- Department of Pediatrics, Emory University, 2015 Uppergate Drive, HSRB W-352, Atlanta, GA, 30322, USA
| | - Katharine E Brock
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Department of Pediatrics, Emory University, 2015 Uppergate Drive, HSRB W-352, Atlanta, GA, 30322, USA.
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Umaretiya PJ, Li A, McGovern A, Ma C, Wolfe J, Bona K. Race, ethnicity, and goal-concordance of end-of-life palliative care in pediatric oncology. Cancer 2021; 127:3893-3900. [PMID: 34255377 DOI: 10.1002/cncr.33768] [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: 12/29/2020] [Revised: 05/04/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Racial and ethnic minority children with cancer disproportionately receive intensive care at the end of life (EOL). It is not known whether these differences are goal-concordant or disparities. The authors sought to explore patterns of pediatric palliative care (PPC) and health care utilization in pediatric oncology patients receiving subspecialty palliative care at the end-of-life (last 6 months) and to examine goal-concordance of location of death in a subset of these patients. METHODS This was a retrospective cohort study of pediatric oncology patients receiving subspecialty palliative care at a single large tertiary care center who died between January 2013 and March 2017. RESULTS A total of 115 patients including 71 White, non-Hispanic patients and 44 non-White patients (including 12 Black patients and 21 Hispanic patients) were included in the analytic cohort. There were no significant differences in oncologic diagnosis, cause of death, or health care utilization in the last 6 months of life. White and non-White patients had similar PPC utilization including time from initial consult to death and median number of PPC encounters. Non-White patients were significantly more likely to die in the hospital compared to White patients (68% vs 46%, P = .03). Analysis of a subcohort with documented preferences (n = 45) revealed that 91% of White patients and 93% of non-White patients died in their preferred location of death. CONCLUSIONS Although non-White children with cancer were more likely to die in the hospital, this difference was goal-concordant in our cohort. Subspecialty PPC access may contribute to the achievement of goal-concordant EOL care.
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Affiliation(s)
- Puja J Umaretiya
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anran Li
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alana McGovern
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts
| | - Clement Ma
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts
| | - Joanne Wolfe
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts
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24
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Upshaw NC, Roche A, Gleditsch K, Connelly E, Wasilewski-Masker K, Brock KE. Palliative care considerations and practices for adolescents and young adults with cancer. Pediatr Blood Cancer 2021; 68:e28781. [PMID: 33089627 DOI: 10.1002/pbc.28781] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022]
Abstract
The definition of adolescents and young adults (AYAs) in oncology varies with upper limits up to age 39. Younger AYAs, ages 12-24 years, are often cared for within pediatrics. In caring for AYAs with cancer, there are unique considerations that become even more important to recognize, acknowledge, and address in AYAs with life-threatening cancer receiving palliative care. This review highlights important factors such as psychosocial development, cultural considerations, and support structure, which should be considered when providing palliative care to AYAs with cancer during the various stages of care: introduction of palliative care; symptom management; advanced care planning (ACP); end-of-life (EOL) care; and bereavement.
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Affiliation(s)
- Naadira C Upshaw
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia.,Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Anna Roche
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Katrina Gleditsch
- Division of Hospice and Palliative Medicine, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina
| | - Erin Connelly
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia.,Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Katharine E Brock
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia.,Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia.,Division of Pediatric Palliative Care, Emory University School of Medicine, Atlanta, Georgia
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25
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Mpody C, Humphrey L, Kim S, Tobias JD, Nafiu OO. Racial Differences in Do-Not-Resuscitate Orders among Pediatric Surgical Patients in the United States. J Palliat Med 2020; 24:71-76. [PMID: 32543271 DOI: 10.1089/jpm.2020.0053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Very few studies have investigated the racial differences in do-not-resuscitate (DNR) orders in children, and these studies are limited to oncological cases. We aim to characterize the racial difference in DNR orders among U.S. pediatric surgical patients. Methods: We retrospectively evaluated the mortality of all children who underwent an inpatient surgery between 2012 and 2017 from the National Surgical Quality Improvement Program. We used log-binomial models to estimate the relative risk (RR) and 95% confidence interval (CI) of DNR use comparing white with African American (AA) children. To estimate the risk-adjusted difference in DNR orders, we controlled the analyses for age, prematurity status, emergent case status, American Society of Anesthesiologists class, year of operation, surgical specialty, and surgical complexity. Results: Between 2012 and 2017, a total of 276,917 children underwent inpatient surgery, of whom 0.8% (n = 1601) died within 30 days of operation. Of the 1601 mortality cases, we retained 1212 children who were of either AA (26.0%, n = 350) or white (63.9%, n = 862) race. Most children were neonates, had an American Society of Anesthesiologists class ≥4 (70.0%, n = 811), and developed one or more postoperative complications (68.7%, n = 833). Overall, AA children were more likely to be neonates at the time of surgery (42.0% vs. 40.3%, p < 0.001), to be premature (66.3% vs. 49.0%, p < 0.001), and develop one or more postoperative complications (73.7% vs. 66.7%, p = 0.017). White children were three times more likely to have a DNR order than their AA peers (adjusted RR: 3.01, 95% CI: 1.09-8.56, p = 0.044). Conclusion: Among pediatric surgical patients in the United States, children of white race were three times more likely to have a DNR order in place than their AA peers despite the latter being "sicker" and more likely to develop postoperative complications. The mechanisms underlying this racial difference deserve further elucidation to improve shared decision making and goal-concordant care.
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Affiliation(s)
- Christian Mpody
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lisa Humphrey
- Division of Palliative Care, Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Stephani Kim
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Olubukola O Nafiu
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
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26
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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.
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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
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27
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Janssen DJA, Rechberger S, Wouters EFM, Schols JMGA, Johnson MJ, Currow DC, Curtis JR, Spruit MA. Clustering of 27,525,663 Death Records from the United States Based on Health Conditions Associated with Death: An Example of big Health Data Exploration. J Clin Med 2019; 8:jcm8070922. [PMID: 31252579 PMCID: PMC6678953 DOI: 10.3390/jcm8070922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Insight into health conditions associated with death can inform healthcare policy. We aimed to cluster 27,525,663 deceased people based on the health conditions associated with death to study the associations between the health condition clusters, demographics, the recorded underlying cause and place of death. Methods: Data from all deaths in the United States registered between 2006 and 2016 from the National Vital Statistics System of the National Center for Health Statistics were analyzed. A self-organizing map (SOM) was used to create an ordered representation of the mortality data. Results: 16 clusters based on the health conditions associated with death were found showing significant differences in socio-demographics, place, and cause of death. Most people died at old age (73.1 (18.0) years) and had multiple health conditions. Chronic ischemic heart disease was the main cause of death. Most people died in the hospital or at home. Conclusions: The prevalence of multiple health conditions at death requires a shift from disease-oriented towards person-centred palliative care at the end of life, including timely advance care planning. Understanding differences in population-based patterns and clusters of end-of-life experiences is an important step toward developing a strategy for implementing population-based palliative care.
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Affiliation(s)
- Daisy J A Janssen
- Department of Research & Education, CIRO, Centre of expertise for chronic organ failure, 6085NM Horn, The Netherlands.
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre (MUMC+), 6229HX Maastricht, The Netherlands.
- Department of Health Services Research, Maastricht University, 6229GT Maastricht, The Netherlands.
| | | | - Emiel F M Wouters
- Department of Research & Education, CIRO, Centre of expertise for chronic organ failure, 6085NM Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 6229HX Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University, 6229GT Maastricht, The Netherlands
- Department of Family Medicine, Maastricht University, 6229HA Maastricht, The Netherlands
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull and York Medical School, University of Hull, Hull HU6 7RX, UK
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW2007 New South Wales, Australia
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA
| | - Martijn A Spruit
- Department of Research & Education, CIRO, Centre of expertise for chronic organ failure, 6085NM Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 6229HX Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, 6229ER Maastricht, The Netherlands
- REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, BE3590 Diepenbeek, Belgium
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