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Ray S, McLorie EV, Downie J. Healthcare Professionals' Attitudes towards and Knowledge and Understanding of Paediatric Palliative Medicine (PPM) and Its Meaning within the Paediatric Intensive Care Unit (PICU): A Summative Content Analysis in a Tertiary Children's Hospital in Scotland-"An In Vitro Study". Healthcare (Basel) 2023; 11:2438. [PMID: 37685471 PMCID: PMC10487473 DOI: 10.3390/healthcare11172438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Background: Paediatric palliative medicine (PPM) is a holistic approach to care for children and their families. Services are growing and developing worldwide but significant disparity in service provision remains. The Paediatric Supportive and Palliative Care Team (PSPCT) at the Royal Hospital for Children in Glasgow was established in 2019, but there is still no clear integrated role within the paediatric intensive care unit (PICU) at present. Through analysing the attitudes, meaning, knowledge and understanding of PPM in the PICU environment, we hoped to explore the experiences of those providing paediatric palliative care and to identify any barriers to or facilitators of integrated working to gain a better understanding of providing this care. Methods: This qualitative study used a survey composed of five open-ended and five closed questions. Sixteen out of a possible thirty-two responses (50%) were accrued from PICU healthcare professionals, including consultants (n = 19), advanced nurse practitioners (n = 4) and band-seven nurses (n = 9). The data were comprehensively studied and analysed by two coders using summative content analysis with assistance from data management software. Codes were further developed to form categories and subcategories. Results: Two categories were found: (1) the role of palliative care and (2) experiences of providing palliative care. A total of five subcategories were found, demonstrating that the PSPCT can enhance care in PICU through collaborative working. Barriers identified included staffing, funding and stigma around palliative care. Conclusions: This study shows that PICU professionals have a good understanding of the concepts of PPM and view it as an essential part of PICU work. Barriers related to resources and misperceptions of palliative care can be overcome through improved education, funding and staff retention, but this would require buy-in from policymakers. The perspective from our relatively small team increases generalizability to growing teams across the country.
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Affiliation(s)
- Satyajit Ray
- Royal Hospital for Children, Glasgow G51 4TF, UK;
| | - Emma Victoria McLorie
- The Paediatric Palliative Care Research Group, Health Sciences, University of York, York YO10 5DD, UK
| | - Jonathan Downie
- Royal Hospital for Children, Glasgow G51 4TF, UK;
- Children’s Hospices Across Scotland (CHAS), Edinburgh EH14 1LT, UK
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Rico-Mena P, Güeita-Rodríguez J, Martino-Alba R, Chocarro-Gonzalez L, Sanz-Esteban I, Palacios-Ceña D. Understanding pediatric palliative care within interdisciplinary palliative programs: a qualitative study. BMC Palliat Care 2023; 22:80. [PMID: 37355579 DOI: 10.1186/s12904-023-01194-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/07/2023] [Indexed: 06/26/2023] Open
Abstract
PURPOSE To describe the process of delivery of pediatric palliative care from the perspective of a pediatric interdisciplinary team and the children's parents. METHODS A qualitative descriptive case study was conducted. Purposeful sampling took place within a specialized pediatric palliative care Unit in Madrid (Spain), located at the Niño Jesus Hospital. The study participants included a specialized pediatric palliative care team from Madrid's pediatric palliative care program, other professional teams involved in interdisciplinary care and parents of children under pediatric palliative care. Data were collected via semi-structured interviews, focus groups and researchers' field notes. A thematic analysis was performed. RESULTS This study included 28 participants (20 women, 8 men), of whom 18 were professionals who belonged to the pediatric palliative care interdisciplinary team, 4 professionals were from other units that collaborated with the pediatric palliative care, and 6 were parents (5 women, 1 man). The mean age of the pediatric palliative care members was 38.2 years (SD ± 7.9), that of the collaborating professionals was 40.5 (SD ± 6.8), and that of the parents was 44.2 (SD ± 5.4). Two main themes emerged: a) Pediatric palliative care has a distinct identity, associated with life. It represents the provision of special care in highly complex children, in the context of the home, far from the hospital environment; b) The team is key: its interdisciplinary organization provides a more comprehensive view of the child and their family, fosters communication among professionals, and improves coordination with other services involved in the care of children. The mindset shift experienced by ID-PPC professionals towards a palliative approach makes them more sensitive to the needs of their patients and leads them to develop specific skills in areas such as communication, decision-making, and adaptability that were identified as differentiating aspects of pediatric palliative care. CONCLUSIONS Describing pediatric palliative care from the professional and parental perspective helps to establish realistic and comprehensive goals for the care of children and their parents. The findings of this study may help with the establishment of a pediatric palliative care team, as a necessary organizational change in a health care system that cares for children with complex and life-threatening conditions. Promoting training in pediatric palliative care, prioritizing more horizontal organizations, providing tools and spaces for coordination and communication between professionals from different services, together with the creation of a position of case coordinator in the care process of children could enhance the understanding of pediatric palliative care services.
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Affiliation(s)
- Patricia Rico-Mena
- Department of Physiotherapy, Chiropody and Dance, Physical Therapy and Health Sciences Research Group, Universidad Europea de Madrid, C. Tajo, S/N, 28670 Villaviciosa de Odón, Madrid, Spain
- International Doctorate School, Rey Juan Carlos University, Madrid, Spain
| | - Javier Güeita-Rodríguez
- Department of Physiotherapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Humanities and Qualitative Research in Health Science Research Group, Universidad Rey Juan Carlos, Madrid, Spain.
| | - Ricardo Martino-Alba
- Pediatric Palliative Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Ismael Sanz-Esteban
- Department of Physiotherapy, Chiropody and Dance, Physical Therapy and Health Sciences Research Group, Universidad Europea de Madrid, C. Tajo, S/N, 28670 Villaviciosa de Odón, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physiotherapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Humanities and Qualitative Research in Health Science Research Group, Universidad Rey Juan Carlos, Madrid, Spain
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Bertaud S, Montgomery AM, Craig F. Paediatric palliative care in the NICU: A new era of integration. Semin Fetal Neonatal Med 2023; 28:101436. [PMID: 37147253 DOI: 10.1016/j.siny.2023.101436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
We are entering a new era of integration between neonatal medicine and paediatric palliative care, with increasing recognition that the role and skills of palliative care extend beyond care of only the terminally ill infant. This paper addresses the principles of paediatric palliative care and how they apply in the NICU, considers who provides palliative care in this setting and outlines the key components of care. We consider how the international standards of palliative care pertain to neonatal medicine and how a fully integrated approach to care may be realised across these two disciplines. Palliative care is so much more than end-of-life care, offering a proactive and holistic approach which addresses the physical, emotional, spiritual and social needs of the infant and family. This is a truly interdisciplinary endeavour, relying on a harmonisation of the skills from both the neonatal and palliative care teams to deliver high-quality coordinated care.
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Affiliation(s)
- Sophie Bertaud
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, UK; Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, UK; Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital, London, UK
| | - Angela M Montgomery
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Finella Craig
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital, London, UK.
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4
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Bernier Carney KM, Goodrich G, Lao A, Tan Z, Kiza AH, Cong X, Hinderer KA. Palliative care referral criteria and application in pediatric illness care: A scoping review. Palliat Med 2023; 37:692-706. [PMID: 36971413 DOI: 10.1177/02692163231163258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Specialty pediatric palliative care services can help to address unmet care needs for children with complex and serious illness. Current guidelines support the identification of unmet palliative care needs; however, it is unknown how these guidelines or other clinical characteristics influence pediatric palliative care referral in research and practice. AIM To evaluate the identification and application of palliative care referral criteria in pediatric illness care and research. DESIGN A scoping review with a content analysis approach to summarize results. DATA SOURCES Five electronic databases (PubMed, CINAHL, PsycINFO, SCOPUS, and Academic Search Premier) were used to identify peer-reviewed literature published in English between January 2010 and September 2021. RESULTS We included 37 articles focused on the referral of pediatric patients to palliative care teams. The identified categories of referral criteria were: disease-related; symptom-related; treatment communication; psychosocial, emotional, and spiritual support; acute care needs; end-of-life care needs; care management needs; and self-referrals for pediatric palliative care services. We identified two validated instruments to facilitate palliative care referral and seven articles which described population-specific interventions to improve palliative care access. Nineteen articles implemented a retrospective health record review approach that consistently identified palliative care needs with varying rates of service use. CONCLUSIONS The literature demonstrates inconsistent methods for identifying and referring children and adolescents with unmet palliative care needs. Prospective cohort studies and clinical trials would inform more consistent pediatric palliative care referral practices. More research is needed on palliative care referral and outcomes in community-focused pediatrics.
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Affiliation(s)
| | - George Goodrich
- School of Nursing, University of Connecticut, Storrs, CT, USA
| | - Amberly Lao
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Zewen Tan
- School of Medicine, University of Connecticut, Farmington, CT, USA
| | | | - Xiaomei Cong
- School of Nursing, University of Connecticut, Storrs, CT, USA
- School of Nursing, Yale University, Orange, CT, USA
| | - Katherine A Hinderer
- School of Nursing, University of Connecticut, Storrs, CT, USA
- School of Medicine, University of Connecticut, Farmington, CT, USA
- Institute for Nursing Research and Evidence-Based Practice, Connecticut Children's, Hartford, CT, USA
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5
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Constantinou G, Cook EJ, Tolliday E, Randhawa G. 'A team around the child' professionals' experiences of unmet needs, access and expectations in children's palliative care services, a phenomenological study in the UK. J Child Health Care 2023:13674935221147716. [PMID: 36946427 DOI: 10.1177/13674935221147716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
This study aims to understand the experiences of professionals involved in caring for families of children with life-limiting illnesses to ascertain unmet needs, access issues and expectations of services.A phenomenological approach comprising semi-structured interviews with professionals from various services was used. Interviews that happened between July and November 2018 were audio-recorded, transcribed verbatim and thematically analysed based on descriptive phenomenology.In total, 29 interviews were conducted. Findings showed how essential collaborative working was for becoming a team around the child. Barriers to this include complex working relationships, overprotectiveness of families, roles and responsibilities and use of independent care records. The pressures of waiting times and the impact of staffing shortages affected the experiences of providing care. The reality of meeting families' expectations was shaped by family networking, online research and previous services resistance, which was influential in more challenging interactions. Expectations of care were also impacted by misunderstandings and anxieties surrounding access to services. Overall, professionals were concerned about families being used as a bottomless caring resource and stressed the need for short breaks to alleviate parents.Interventions that educate families and professionals on these services and how they can benefit the child and family would be well received.
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Affiliation(s)
- Georgina Constantinou
- Institute for Health Research, 5195University of Bedfordshire, UK
- Centre for Maternal and Child Health Research, School of Health Sciences, 4895City University of London, London, UK
| | - Erica J Cook
- Department of Psychology, 5195University of Bedfordshire, UK
| | | | - Gurch Randhawa
- Institute for Health Research, 5195University of Bedfordshire, UK
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AGRAWAL UMASHANKER, SARIN JYOTI, BAKHSHI SAMEER, GARG RAKESH. Challenges and opportunities in providing palliative care services to children with a life-limiting illness: A systematic review. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 35:284-289. [PMID: 37167501 DOI: 10.25259/nmji_349_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Background
Palliative care for children is an innovative approach that helps improve the quality of life of children suffering from life-limiting illnesses, and their family members. The WHO recognized palliative care as a part of universal health coverage. However, there is inadequate availability and inequitable distribution of palliative care services for children in most parts of the world. We reviewed the existing literature to assess (i) the challenges in providing palliative care services for children suffering from life-limiting illnesses and (ii) the strategies or opportunities to overcome these challenges.
Methods
We conducted systematic searches in the PubMed and Scopus databases to find articles published in the past 10 years (January 2011 to December 2020). The population, concept and context (PCC) framework was used to devise a search strategy in an electronic database.
Results
A total of 1562 articles were found by searching the database and other sources. Title and abstracts of articles were screened, and 206 articles were selected for full-text review. After scrutiny 28 articles met the inclusion criteria. Barriers to and opportunities in the provision of palliative care services for children were identified at policy, organizational, healthcare provider, and patient/family levels.
Conclusion
We found that the majority of barriers to provision of palliative care services for children with life-limiting illnesses can be addressed by adopting research-driven strategies. Adequate and equitable distribution of palliative care services is required for improving children and their family members’ quality of life.
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Affiliation(s)
- UMA SHANKER AGRAWAL
- Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - JYOTI SARIN
- MM College of Nursing, Maharishi Markandeshwar University, Mullana, Ambala 133203, Haryana, India
| | - SAMEER BAKHSHI
- Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - RAKESH GARG
- Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Riiser K, Holmen H, Winger A, Steindal SA, Castor C, Kvarme LG, Lee A, Lorentsen VB, Misvaer N, Früh EA. Stories of paediatric palliative care: a qualitative study exploring health care professionals' understanding of the concept. BMC Palliat Care 2022; 21:187. [PMID: 36273144 PMCID: PMC9587603 DOI: 10.1186/s12904-022-01077-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
Background By sharing patient stories, health care professionals (HCPs) may communicate their attitudes, values and beliefs about caring and treatment. Previous qualitative research has shown that HCPs usually associate paediatric palliative care (PPC) with death or dying and that they find the concept challenging to understand and difficult to implement. Attending to HCPs’ stories may provide a richer account of their understanding of PPC. Thus, the aim of this study was to explore PPC stories narrated by HCPs to gain increased insight into their understanding of what PPC entails. Methods This qualitative study collected data from four focus group interviews with 21 HCPs from different units in two Norwegian hospitals. Stories told by the HCPs to illustrate their comprehension of PPC were analysed following thematic analysis procedures. Results Four themes were identified illustrating what PPC meant to the participants: creating spaces for normality, providing tailored support for the family, careful preparations for saying goodbye and experiencing dilemmas and distress. The stories centred on family care, particularly relating to dramatic or affective situations when the death of a child was imminent. Conclusion The stories reflect how the HCPs view PPC as a specific field of health care that requires particular professional sensitivity, including good communication, collaboration and planning. Thus, the HCPs in this study demonstrated knowledge about the core qualities needed to succeed in PPC. However, similar to previous research, the stories illustrate that how HCPs speak about PPC is strongly associated with end-of-life care, and by that the HCPs do not capture the breadth of the PPC concept. The findings highlight the importance of increasing knowledge about the meaning and content of PPC among HCPs in order to maintain quality of life for all children with life-limiting or life-threatening conditions throughout their illness trajectory.
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Affiliation(s)
- Kirsti Riiser
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway.
| | - Heidi Holmen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway
| | - Anette Winger
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggt. 15b, NO-0456, Oslo, Norway
| | - Charlotte Castor
- Department of Health Sciences, Faculty of Medicine, Lund University, SE-221 00, Lund, Box 157, Sweden
| | - Lisbeth Gravdal Kvarme
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway
| | - Anja Lee
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, NO-0424, Ullevål, Nydalen, Oslo, PO Box 4950, Norway
| | - Vibeke Bruun Lorentsen
- Department of Nursing, Faculty of Health Studies, VID Specialized University, NO-0319, Vinderen, Oslo, PO Box 184, Norway
| | - Nina Misvaer
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway
| | - Elena Albertini Früh
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway
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8
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Papworth A, Hackett J, Beresford B, Murtagh F, Weatherly H, Hinde S, Bedendo A, Walker G, Noyes J, Oddie S, Vasudevan C, Feltbower R, Phillips B, Hain R, Subramanian G, Haynes A, Fraser LK. End of life care for infants, children and young people (ENHANCE): Protocol for a mixed methods evaluation of current practice in the United Kingdom [version 1; peer review: 2 approved]. NIHR OPEN RESEARCH 2022; 2:37. [PMID: 35935675 PMCID: PMC7613236 DOI: 10.3310/nihropenres.13273.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/22/2022]
Abstract
Background Although child mortality has decreased over the last few decades, around 4,500 infants and children die in the UK every year, many of whom require palliative care. There is, however, little evidence on paediatric end-of-life care services. The current National Institute for Health and Care Excellence (NICE) guidance provides recommendations about what should be offered, but these are based on low quality evidence. The ENHANCE study aims to identify and investigate the different models of existing end-of-life care provision for infants, children, and young people in the UK, including an assessment of the outcomes and experiences for children and parents, and the cost implications to families and healthcare providers. Methods This mixed methods study will use three linked workstreams and a cross-cutting health economics theme to examine end-of-life care models in three exemplar clinical settings: infant, children and young adult cancer services (PTCs), paediatric intensive care units (PICUs), and neonatal units (NNUs).Workstream 1 (WS1) will survey current practice in each setting and will result in an outline of the different models of care used. WS2 is a qualitative comparison of the experiences of staff, parents and patients across the different models identified. WS3 is a quantitative assessment of the outcomes, resource use and costs across the different models identified. Discussion Results from this study will contribute to an understanding of how end-of-life care can provide the greatest benefit for children at the end of their lives. It will also allow us to understand the likely benefits of additional funding in end-of-life care in terms of patient outcomes.
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Affiliation(s)
- Andrew Papworth
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Julia Hackett
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Bryony Beresford
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
- Social Policy Research Unit, University of York, Heslington, York, YO10 5DD, UK
| | - Fliss Murtagh
- Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
| | - Helen Weatherly
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Sebastian Hinde
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Andre Bedendo
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | | | - Jane Noyes
- School of Health Sciences, Bangor University, Fron Heulog, Bangor, LL57 2EF, UK
| | - Sam Oddie
- Bradford Hospitals National Health Service Trust, Bradford, BD9 6RJ, UK
| | | | - Richard Feltbower
- Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9NL, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, UK, York, YO10 5DD, UK
| | - Richard Hain
- All-Wales Paediatric Palliative Care Network, Cardiff and Vale University Health Board, Cardiff, CF14 4XW, UK
- College of Human and Health Sciences, Swansea University, Swansea, SA2 8PP, UK
| | - Gayathri Subramanian
- Manchester University National Health Service Foundation Trust, Manchester, M13 9WL, UK
| | - Andrew Haynes
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Lorna K Fraser
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
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Santini A, Avagnina I, Marinetto A, De Tommasi V, Lazzarin P, Perilongo G, Benini F. The Intervention Areas of the Psychologist in Pediatric Palliative Care: A Retrospective Analysis. Front Psychol 2022; 13:858812. [PMID: 35391957 PMCID: PMC8980523 DOI: 10.3389/fpsyg.2022.858812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Infants, children and adolescents with life-limiting and life-threatening disease need long-term care that may change according to disease's natural history. With the primary goal of quality of life, the psychologist of pediatric palliative care (PPC) network deals with a large variety of issues. Little consideration has been given to the variety of intervention areas of psychology in PPC that concern the whole life span of the patient and family. The PPC network is composed by a multidisciplinary team of palliative care specialists that intervenes at home, in the hospital and in every place where the patient is living. The network coordinates different public health services to respond to clinical, psychosocial and spiritual needs. In these scenarios, the psychological need is not a single event but a moment inserted in the complexity of the child's needs. This retrospective monocentric project consists of an analysis of characteristics of psychological interventions in our PPC service. The time frame taken into consideration is 2019-2020, analyzing the clinical records of 186 patients of Pediatric Palliative Care and Pain Service of Veneto Region (Italy). The areas that emerged in the analysis show how the intervention of the psychologist in PPC does not concern only end-of-life, but a series of topics that are significant for the family to guarantee psycho-social wellbeing oriented toward the best quality of life. In conclusion, these different topics highlight the complexity of the child and family experience. This variety must be taken into consideration, the psychologist must increase holistic support with a dedicated skills curriculum.
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Affiliation(s)
- Anna Santini
- Pediatric Pain and Palliative Care Service, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Irene Avagnina
- Pediatric Pain and Palliative Care Service, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Anna Marinetto
- Pediatric Pain and Palliative Care Service, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Valentina De Tommasi
- Pediatric Pain and Palliative Care Service, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Pierina Lazzarin
- Pediatric Pain and Palliative Care Service, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Giorgio Perilongo
- Department of Women’s and Children’s Health, School of Medicine, University of Padua, Padua, Italy
| | - Franca Benini
- Pediatric Pain and Palliative Care Service, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
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10
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Delgado-Corcoran C, Wawrzynski SE, Mansfield KJ, Flaherty B, DeCourcey DD, Moore D, Cook LJ, Ullrich CK, Olson LM. An Automatic Pediatric Palliative Care Consultation for Children Supported on Extracorporeal Membrane Oxygenation: A Survey of Perceived Benefits and Barriers. J Palliat Med 2022; 25:952-957. [PMID: 35319287 DOI: 10.1089/jpm.2021.0452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Pediatric palliative care (PPC) consultation is infrequent among children on extracorporeal membrane oxygenation (ECMO). Objective: Investigate intensive care unit (ICU) team members' perceptions of automatic PPC consultation for children on ECMO in an ICU in the United States. Methods: Cross-sectional survey assessing benefits, barriers to PPC, and consultation processes. Results: Of 291 eligible respondents, 48% (n = 140) completed the survey and 16% (n = 47) answered an open-ended question. Benefits included support in decision-making (n = 98; 70%) and identification of goals of care (n = 89; 64%). Barriers included perception of giving up on families (n = 59; 42%) and poor acceptability by other team members (n = 58; 41%). Respondents endorsed communication with the primary ICU team before (n = 122; 87%) and after (n = 129; 92%) consultation. Open-ended responses showed more positive (79% vs. 13%) than negative statements. Positive statements reflected on expanding PPC to other critically-ill children where negative statements revealed unrecognized value in PPC. Conclusions: Results demonstrate opportunities for education about the scope of PPC and improvements in PPC delivery.
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Affiliation(s)
- Claudia Delgado-Corcoran
- Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.,Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Sarah E Wawrzynski
- Pediatric Critical Care Services, Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, Utah, USA.,College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | | | - Brian Flaherty
- Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Danielle D DeCourcey
- Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Dominic Moore
- Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Lawrence J Cook
- Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Christina K Ullrich
- Division of Pediatric Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Lenora M Olson
- Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
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11
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Vemuri S, Butler AE, Brown K, Wray J, Bluebond-Langner M. Palliative care for children with complex cardiac conditions: survey results. Arch Dis Child 2022; 107:282-287. [PMID: 34312164 PMCID: PMC8862095 DOI: 10.1136/archdischild-2020-320866] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 07/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore perspectives of paediatric cardiac and palliative care professionals on providing palliative care to children with complex cardiac conditions. DESIGN A national survey including closed-ended and open-ended questions as well as clinical scenarios designed to capture referral practices, attitudes towards palliative care, confidence delivering key components of palliative care and perspectives on for whom to provide palliative care. Responses to closed-ended questions and scenarios were analysed using descriptive statistics. Open-ended responses were analysed thematically. PARTICIPANTS Paediatric cardiac and palliative care professionals caring for children with complex cardiac conditions in the UK. RESULTS 177 professionals (91 cardiac care and 86 palliative care) responded. Aspects of advance care planning were the most common reasons for referral to palliative care. Palliative care professionals reported greater confidence than cardiac colleagues with such discussions. Clinicians agreed that children with no further surgical management options, comorbid genetic disorders, antenatal diagnosis of a single ventricle, ventricular device in situ, symptomatic heart failure and those awaiting heart transplantation would benefit from palliative care involvement. CONCLUSIONS Components of palliative care, such as advance care planning, can be provided by cardiac care professionals alongside the disease-directed care of children with complex cardiac conditions. Further research and training are needed to address confidence levels in cardiac care professionals in delivering components of palliative care as well as clarification of professional roles and parent preferences in delivery of family-centred care for children with complex cardiac conditions.
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Affiliation(s)
- Sidharth Vemuri
- Victorian Paediatric Palliative Care Program, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia,Louis Dundas Centre for Children's Palliative Care, University College London Great Ormond Street Institute for Child Health, London, UK
| | - Ashleigh E Butler
- Louis Dundas Centre for Children's Palliative Care, University College London Great Ormond Street Institute for Child Health, London, UK,Austin Health Clinical School, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Katherine Brown
- Institute of Cardiovascular Science, University College London, London, UK,Heart Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jo Wray
- Institute of Cardiovascular Science, University College London, London, UK,Heart Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK,Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children's Palliative Care, University College London Great Ormond Street Institute for Child Health, London, UK .,Rutgers University, Camden, New Jersey, USA
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12
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Mitchell S, Slowther AM, Coad J, Dale J. Experiences of healthcare, including palliative care, of children with life-limiting and life-threatening conditions and their families: a longitudinal qualitative investigation. Arch Dis Child 2021; 106:570-576. [PMID: 33199300 PMCID: PMC8142456 DOI: 10.1136/archdischild-2020-320189] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To understand the experiences and perceptions of healthcare services of children with life-limiting and life-threatening conditions and their family members, including palliative care. DESIGN Longitudinal qualitative interview study with children and their family members. Up to three in-depth interviews were conducted over 13 months with each child and family. Data were analysed using thematic analysis. SETTING Community and hospital settings in the West Midlands, UK. PARTICIPANTS Children with a diverse range of life-limiting and life-threatening conditions, aged between 5 and 18 years, and their family members. FINDINGS 31 participants from 14 families including 10 children took part in 41 interviews. Two children died during the course of the study. Children accepted their conditions as part of life and had other priorities for living. Experiences of 'fighting' a fragmented healthcare system that focused on the biomedical aspects of their care were described. The possibility of death was rarely openly discussed. Palliative care tended to be conceptualised as a distinct service or phase of a child's condition, rather than a broad approach. Access to palliative care depended on the availability of specialist services, and on trusted interpersonal relationships with healthcare professionals who could share uncertainty and the family's emotional burden. CONCLUSIONS There is an urgent need to create a more child and family centred approach that enables palliative care to be truly integrated into the wider healthcare of children with life-limiting and life-threatening conditions. Trusted, interpersonal relationships with healthcare professionals, and more effective coordination of care are fundamental to achieving this, and should be valued and enabled throughout the healthcare system.
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Affiliation(s)
- Sarah Mitchell
- Academic Unit of Primary Care, University of Warwick, Coventry, UK .,Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | | | - Jane Coad
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Jeremy Dale
- Academic Unit of Primary Care, University of Warwick, Coventry, UK
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13
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Song IG, Kwon SY, Chang YJ, Kim MS, Jeong SH, Hahn SM, Han KT, Park SJ, Choi JY. Paediatric palliative screening scale as a useful tool for clinicians' assessment of palliative care needs of pediatric patients: a retrospective cohort study. BMC Palliat Care 2021; 20:73. [PMID: 34030666 PMCID: PMC8146205 DOI: 10.1186/s12904-021-00765-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/07/2021] [Indexed: 11/26/2022] Open
Abstract
Background Although the importance of palliative care in pediatric patients has been emphasized, many health care providers have difficulty determining when patients should be referred to the palliative care team. The Paediatric Palliative Screening Scale (PaPaS) was developed as a tool for screening pediatric patients for palliative care needs. The study aimed to evaluate the PaPaS as a reliable tool for primary care clinicians unfamiliar with palliative care. Methods This was a retrospective cohort study of patients referred to the pediatric palliative care teams in two tertiary hospitals in the Republic of Korea between July 2018 and October 2019. Results The primary clinical and pediatric palliative care teams assessed the PaPaS scores of 109 patients, and both teams reported a good agreement for the sum of the PaPaS score. Furthermore, the PaPaS scores correlated with those obtained using the Lansky performance scale. Although the mean PaPaS score was higher in the pediatric palliative care team, the scores were higher than the cut-off score for referral in both groups. Conclusion The PaPaS can be a useful tool for primary care clinicians to assess the palliative care needs of patients and their families.
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Affiliation(s)
- In Gyu Song
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Republic of Korea.,National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Seung Yeon Kwon
- Palliative Care Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.,Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Yoon Jung Chang
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea.
| | - Min Sun Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Sung Hoon Jeong
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea.,Department of Public Health, Graduate school, Yonsei University, Seoul, Republic of Korea
| | - Seung Min Hahn
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea.,Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Kyu Tae Han
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - So-Jung Park
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Jin Young Choi
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
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14
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Dunbar H, Carter B. Experiencing place identity and place belongingness at a children's hospice: Parents' perspectives. J Child Health Care 2021; 25:161-171. [PMID: 32216572 DOI: 10.1177/1367493520915134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children's hospices are key players in the provision of palliative care services for families with children with life-limiting conditions (LLCs). However, evidence suggests that some of the negative terminology/language which surrounds the notions of palliative and hospice care may contribute to the lack of uptake of hospice services by families. This article reports two elements of place bonding: parents' experiences of place identity and place belongingness at a children's hospice in a region in England. Underpinned by a constructivist grounded theory methodology, focus groups were undertaken with 24 parents of children with LLCs accessing a children's hospice. Despite initial reservations associated with the identity of the hospice, parents described how and why their view changed and therefore consequently how they were able to experience the hospice differently. This article demonstrates how parents' views of the identity of the hospice change and how the hospice becomes a place where parents experience a sense of belongingness.
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Affiliation(s)
- Helena Dunbar
- Leicester School of Nursing and Midwifery, De Montfort University, Leicester, UK
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK
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15
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TAŞ F, SOYLU D, SOYLU A. Hemşirelerin Palyatif Bakımla İlgili Bilgi ve Tutumları. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.848353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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16
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Zhang M, Li X. Focuses and trends of the studies on pediatric palliative care:A bibliometric analysis from 2004 to 2018. Int J Nurs Sci 2021; 8:5-14. [PMID: 33575439 PMCID: PMC7859508 DOI: 10.1016/j.ijnss.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/10/2020] [Accepted: 11/26/2020] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To investigate the focuses and trends of the studies on pediatric palliative care (PPC) and provide directions for future research. METHODS Relevant papers about PPC published from 2004 to 2018 were analyzed using bibliometric analysis methods, including co-word analysis, biclustering analysis, and strategic diagram analysis. The included papers were divided into three groups based on the publication time, including 2004-2008, 2009-2013, and 2014-2018. RESULTS A total of 1132 papers were published between 2004 and 2018, and there were 293 papers published between 2004 and 2008, 396 between 2009 and 2013, and 443 between 2014 and 2018. There were 42 high-frequency MeSH terms/MeSH subheadings in papers published between 2004 and 2018, including 12 between 2004 and 2008, 13 between 2009 and 2013, and 17 between 2014 and 2018. CONCLUSION Studies on PPC were making progress, with the increasing number, expanding scope, and uneven global distribution. Integration palliative care into pediatrics, cancer treatments in pediatric oncology, education methods on PPC, and establishment of professional teams were the major themes during 2004-2008, then the themes changed into establishing interventions to enhance the quality of life of the patients and parents, building professional-family relationship, and investigating attitude of health personnel in PPC during 2009-2013 and subsequently turned into communication skills, end-of-life decision making, and guidelines making on PPC during 2014-2018. Underdeveloped and protential themes including effective approaches to deal with the ethical dilemmas, training programs on communication skills, family support and guideline making are worth studying in the future.
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Affiliation(s)
- Miao Zhang
- School of Nursing, China Medical University, Shenyang, Liaoning, China
| | - Xiaohan Li
- School of Nursing, China Medical University, Shenyang, Liaoning, China
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17
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Neuburg L. Early Initiation of Pediatric Palliative Care. J Pediatr Health Care 2021; 35:114-119. [PMID: 32660809 DOI: 10.1016/j.pedhc.2020.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 11/20/2022]
Abstract
Pediatric palliative care (PPC) literature was utilized to identify barriers for early initiation of palliative care at diagnosis among children with life-threatening diseases. Early integration of PPC enhances quality of life and reduces suffering in these children, but many clinicians fail to initiate advanced care planning, establish goals of care, and refer to specialists. Barriers to early PPC initiation include clinician misperceptions, emotional toll on clinicians, and prognostic uncertainty about treatment options and care management strategies. Pediatric nurse practitioners can increase awareness, educate, and support other clinicians to promote early initiation of PPC in children with life-threatening diseases.
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18
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Andriastuti M, Halim PG, Kusrini E, Bangun M. Correlation of Pediatric Palliative Screening Scale and Quality of Life in Pediatric Cancer Patients. Indian J Palliat Care 2020; 26:338-341. [PMID: 33311876 PMCID: PMC7725190 DOI: 10.4103/ijpc.ijpc_197_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 05/14/2020] [Indexed: 11/04/2022] Open
Abstract
Context Palliative care in children is used to be only intended for those in near end-of-life phase. Ideally, palliative intervention should be given since the first time of cancer diagnosis. Palliative care is introduced from the beginning of the treatment by acknowledging that it helps to ensure an ongoing focus on the quality of life (QOL) so that children still can enjoy their life. Several approaches have been used to identify children with the need of palliative care. Aims The aim was to describe the use of Paediatric Palliative Screening Scale (PaPaS Scale) and its depiction to the QOL of children with malignancies. Settings and Design A cross-sectional study was conducted in sixty children age 2-18 years with malignancies, who were consulted to the palliative team. Subjects and Methods Sixty participants were recruited randomly during the study. PaPaS Scale and QOL (using PedsQL™ cancer module 3.0) were assessed at the same time. Cutoff points of 67 for parent-proxy report and 68.9 for self-report were used, those who have scores <67 and <68.9 were grouped as low QOL group. PaPaS scale was divided into three groups: (1) no palliative care needs (score 10-14), (2) considered palliative care (15-24), and (3) need for palliative (≥25). Statistical Analysis Differences between palliative score and QOL were analyzed using Chi-square and Fisher test. Results Children who have lower QOL based on parent-proxy report (<67) included 25 children; they consist of 16 children (64%) with score 10-14, four children (16%) with score 15-24, and five children (20%) with score ≥25. Children with higher QOL (16 children) consist of ten children (62.5%) with score 10-14, four children (25%) scores 15-24, and two children (12.5%) with score ≥25. In the self-report, children with low QOL (eight children) consist of four children (50%) with score 10-14, four children (50%) with score 15-24, and no children with score ≥ 25. Children with higher QOL (11 children) consist of eight children (72.2%) with score 10-14, two children (18.2%) with scores 15-24, and one child (9.1%) with score ≥25. Statistical analysis showed no correlation between PaPaS score and QOL of children with malignancies in parent-proxy report (P = 0.89) and self-report (P = 0.37). Conclusions This study showed that children with malignancies already had lower QOL despite the low PaPaS scale they had. The results of this study support the provision of early palliative intervention, starting with a small proportion of intervention to improve the QOL of cancer child.
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Affiliation(s)
- Murti Andriastuti
- Department of Child Health, Faculty of Medicine Indonesia University, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Pricilia Gunawan Halim
- Department of Child Health, Faculty of Medicine Indonesia University, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Eny Kusrini
- Pediatric Nurse, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Meidiana Bangun
- Pediatric Nurse, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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19
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Mulligan S, Guerin S, McKiernan A, Brown A, Hartnett M, Gray D, Kiernan G. The core features and outcomes of a specialised camp programme for children with life-limiting conditions and their families: A qualitative multi-perspective approach. J Child Health Care 2020; 24:515-528. [PMID: 31594387 DOI: 10.1177/1367493519875593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous research has reported that the families of children with enduring and life-limiting health conditions are at risk of negative psychosocial effects. Adjunct to medical interventions, specialist camp programmes have been developed to promote familial adjustment. However, limited research has been carried out in this area. The aim of this study was to describe the core features and outcomes of a specialised camp programme for children with life-limiting conditions (LLC) and their family. Semi-structured interviews were conducted with four professionals, three volunteers involved in facilitating the programme and two mothers representing families that attended the programme. Multiple perspectives were sought to gain a detailed understanding of the programme and outcomes. Data were analysed through an inductive thematic approach. There was considerable overlap among participant groups on the core features and outcomes of the programme. Thematically, core features are described in terms of familial togetherness, peer interaction, safety and positive experiences. Noted outcomes include lasting memories, continued peer relations for parents and siblings and enhancement of relationships between family members and professionals. Findings suggest that specialised camp programmes may provide families of children with LLC with positive experiences that support adjustment, although further research is required.
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Affiliation(s)
- Shane Mulligan
- UCD School of Psychology, University College Dublin, Dublin, Ireland
| | - Suzanne Guerin
- UCD School of Psychology, University College Dublin, Dublin, Ireland
| | | | - Anna Brown
- LauraLynn, Ireland's Children's Hospice, Dublin, Ireland
| | | | - Dee Gray
- LauraLynn, Ireland's Children's Hospice, Dublin, Ireland
| | - Gemma Kiernan
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
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20
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Salins N, Ghoshal A, Hughes S, Preston N. How views of oncologists and haematologists impacts palliative care referral: a systematic review. BMC Palliat Care 2020; 19:175. [PMID: 33228651 PMCID: PMC7686696 DOI: 10.1186/s12904-020-00671-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Worldwide, many patients with cancer, are infrequently referred to palliative care or are referred late. Oncologists and haematologists may act as gatekeepers, and their views may facilitate or hinder referrals to palliative care. This review aimed to identify, explore and synthesise their views on referrals systematically. METHODS Databases of MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, Web of Science and Cochrane were searched for articles from 01/01/1990 to 31/12/2019. All studies were scored for their methodological rigour using Hawker's tool. Findings were synthesised using Popay's narrative synthesis method and interpreted using a critical realist lens and social exchange theory. RESULTS Out of 9336 initial database citations, 23 studies were included for synthesis. Five themes were developed during synthesis. 1. Presuppositions of oncologists and haematologists about palliative care referral: Role conflict, abandonment, rupture of therapeutic alliance and loss of hope were some of the presuppositions that hindered palliative care referral. Negative emotions and perception of self-efficacy to manage palliative care need also hindered referral. 2. Power relationships and trust issues: Oncologists and haematologists preferred to gatekeep the referral process and wished to control and coordinate the care process. They had diminished trust in the competency of palliative care providers. 3. Making a palliative care referral: A daunting task: The stigma associated with palliative care, navigating illness and treatment associated factors, addressing patient and family attitudes, and overcoming organisational challenges made referral a daunting task. Lack of referral criteria and limited palliative care resources made the referral process challenging. 4. Cost-benefit of palliative care referral: Pain and symptom management and psychosocial support were the perceived benefits, whereas inconsistencies in communication and curtailment of care were some of the costs associated with palliative care referral. 5. Strategies to facilitate palliative care referral: Developing an integrated model of care, renaming and augmenting palliative care resources were some of the strategies that could facilitate a referral. CONCLUSION Presuppositions, power relationships, trust issues and the challenges associated with the task of referrals hindered palliative care referral. Oncologists and haematologists appraised the cost-benefit of making a palliative care referral. They felt that an integrated model of care, changing the name of palliative care and augmenting palliative care resources might facilitate a referral.
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Affiliation(s)
- Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Centre, MB-G-75, DR E Borges Road, Parel, Mumbai, 400012, India
| | - Sean Hughes
- Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, C051, C - Floor, Bailrigg, LA1 4YW, UK
| | - Nancy Preston
- Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, C051, C - Floor, Bailrigg, LA1 4YW, UK.
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21
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Coombs S, Aouad P, Jaaniste T. Factors Associated With the Location of Expected Pediatric Deaths in the Palliative Care Context. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:850-867. [PMID: 32938305 DOI: 10.1177/0030222820959941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Early planning and knowing which factors to consider when planning the location of death (LOD) of a palliative child, may help minimize the burden of hasty decision-making in the future, and may provide families with a sense of control. The current paper reviewed which factors were associated with pediatric LOD and further considered some emerging factors that should are important to better facilitate integrative planning. Three overarching areas of consideration related to pediatric LOD planning were identified including health service factors, familial factors and patient factors. Multiple sub-factor considerations are presented. Further, the paper presents a conceptual model of the factors found to be related to pediatric LOD planning. The limitations that exist with rigorously and empirically studying pediatric LOD preferences are apparent from the dearth of knowledge seen in the field. However, future studies should continue to examine such factors more closely to better understand the nuanced implications.
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Affiliation(s)
- Sandra Coombs
- Departments of Pain and Palliative Care, Sydney Children's Hospital - Randwick, Sydney, Australia
| | - Phillip Aouad
- Departments of Pain and Palliative Care, Sydney Children's Hospital - Randwick, Sydney, Australia
- Department of Pain, Sydney Children's Hospital - Randwick, Sydney, Australia
| | - Tiina Jaaniste
- Departments of Pain and Palliative Care, Sydney Children's Hospital - Randwick, Sydney, Australia
- Department of Pain, Sydney Children's Hospital - Randwick, Sydney, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
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22
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Johnston EE, Martinez I, Currie E, Brock KE, Wolfe J. Hospital or Home? Where Should Children Die and How Do We Make That a Reality? J Pain Symptom Manage 2020; 60:106-115. [PMID: 31887402 DOI: 10.1016/j.jpainsymman.2019.12.370] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 01/31/2023]
Abstract
CONTEXT Most of the 20,000 U.S. children dying of serious illnesses annually die in the hospital. It is unknown if this hospital death predominance reflects family wishes or systemic issues such as lack of hospice access. Hence, we need to better understand location of death preferences for children and their families. OBJECTIVE To better understand location of death preferences in North America, we reviewed the literature to examine the evidence for and against home death in seriously ill children (0-18 years). METHODS We searched English articles in PubMed, PsycINFO, and Embase published during 2000-2018 for articles related to parental, child/adolescent, and provider preference for death location and articles that correlated death location with bereavement or quality of life outcomes. RESULTS The search results (n = 877 articles and n = 58 abstracts of interest) were reviewed, and 34 relevant articles were identified. Parent, child, and provider preferences, bereavement outcomes, and associated factors all point to some preference for home death. These findings should be interpreted with several caveats: 1) many studies are small and prone to selection bias, 2) not all families prefer home death and some that do are not able to achieve home death due to inadequate home support, 3) studies of bereavement outcomes are lacking. CONCLUSION Adequate resources are needed to ensure children can die in their chosen location-be that home, hospital, or free-standing hospice. This review highlights research areas needed to better understand death location preference and programs and policies that will support home death for those that desire it.
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Affiliation(s)
- Emily E Johnston
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Isaac Martinez
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Erin Currie
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Katharine E Brock
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA; Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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23
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Kyc SJ, Bruno CJ, Shabanova V, Montgomery AM. Perceptions of Neonatal Palliative Care: Similarities and Differences between Medical and Nursing Staff in a Level IV Neonatal Intensive Care Unit. J Palliat Med 2020; 23:662-669. [DOI: 10.1089/jpm.2019.0523] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stephanie J. Kyc
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christie J. Bruno
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Veronika Shabanova
- Department of Pediatrics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Angela M. Montgomery
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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24
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Chong PH, Soo J, Yeo ZZ, Ang RQ, Ting C. Who needs and continues to need paediatric palliative care? An evaluation of utility and feasibility of the Paediatric Palliative Screening scale (PaPaS). BMC Palliat Care 2020; 19:18. [PMID: 32041616 PMCID: PMC7011544 DOI: 10.1186/s12904-020-0524-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 02/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background While the populations of children who can benefit from paediatric palliative care (PPC) have been broadly defined, identifying individual patients to receive PPC has been problematic in practice. The Paediatric Palliative Screening scale (PaPaS) is a multi-dimensional tool that assesses palliative care needs in children and families to facilitate timely referrals. This study evaluates its use to manage new referrals and ongoing review of patients receiving home-based PPC in Singapore. Methods Using a retrospective cohort study design, 199 patients admitted to receive PPC via clinician screening were scored using PaPaS. Eighty-four patients in two groups were scored again at one of two following milestones: one-year service continuation mark or point of discharge before a year. Accuracy measures were compared against clinical assessment. Results 96.98% of patients scored 15 and above on admission (indicating need for PPC). Patients assessed at following milestones were effectively stratified; those who continued to receive service after 1 year scored significantly higher (M = 19.23) compared to those who were discharged within a year (M = 7.86). Sensitivity and specificity for PaPaS were calculated at 82.54 and 100% respectively. Overall congruence with clinician-based decisions supports the utility of PaPaS as a screening tool in PPC. Recommendations to improve the scale further are proposed. Conclusion The PaPaS is a practical screening tool that signposts PPC needs within the clinical setting. This facilitates early referrals to PPC, without having to specify individual prognoses that are often uncertain. Other benefits include optimised continuity of care and implications for resource allocation.
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Affiliation(s)
- Poh Heng Chong
- HCA Hospice Care, 705 Serangoon Road, #03-01 Block A @ Kwong Wai Shiu Hospital, Singapore, 328127, Singapore.
| | - Janice Soo
- Ministry of Health Holdings, Singapore, Singapore
| | - Zhi Zheng Yeo
- HCA Hospice Care, 705 Serangoon Road, #03-01 Block A @ Kwong Wai Shiu Hospital, Singapore, 328127, Singapore
| | - Raymond Qishun Ang
- HCA Hospice Care, 705 Serangoon Road, #03-01 Block A @ Kwong Wai Shiu Hospital, Singapore, 328127, Singapore
| | - Celene Ting
- HCA Hospice Care, 705 Serangoon Road, #03-01 Block A @ Kwong Wai Shiu Hospital, Singapore, 328127, Singapore
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Barriers to Early Utilization of Palliative Care in Heart Failure: A Narrative Review. Healthcare (Basel) 2020; 8:healthcare8010036. [PMID: 32046146 PMCID: PMC7151150 DOI: 10.3390/healthcare8010036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/01/2020] [Accepted: 02/03/2020] [Indexed: 12/05/2022] Open
Abstract
Palliative care is indicated in patients with heart failure since the early phases of the disease, as suggested by international guidelines. However, patients are referred to palliative care very late. Many barriers could explain the gap between the guidelines’ indications and clinical practice. The term palliative is perceived as a stigma by doctors, patients, and family members because it is charged with negative meanings, a poor prognosis, and no hope for improvement. Many authors prefer the term supportive care, which could facilitate a discussion between doctors, patients, and caregivers. There is substantial variation and overlap in the meanings assigned to these two terms in the literature. Prognosis, as the main indication to palliative care, delays its implementation. It is necessary to modify this paradigm, moving from prognosis to patients’ needs. The lack of access to palliative care programs is often due to a lack of palliative care specialists and this shortage will be greater in the near future. In this study, a new model is proposed to integrate early over the course of the disease the palliative care (PC) specialist in the heart failure team, allowing to overcome the barriers and to achieve truly simultaneous care in the treatment of heart failure (HF) patients.
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Gottardo NG. 'Walking their walk': reducing conflict between families of ill children and the medical profession. Arch Dis Child 2020; 105:87-89. [PMID: 31431435 DOI: 10.1136/archdischild-2019-317387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/24/2019] [Accepted: 07/28/2019] [Indexed: 11/04/2022]
Abstract
In recent years, several high-profile court cases generated headlines across the globe. Notably, they brought conflict between families of seriously ill children and the medical profession to the forefront. These conflicts, especially when the courts become involved, are highly destructive to all parties concerned, as the focus inevitably shifts from the child to the conflict itself. Often, at the heart of conflict, is a lack of effective communication between a patient's family and their health providers. In order to assist health workers in the prevention, recognition and management of conflict in paediatrics, a Conflict Management Framework (CMF) and a set of guidelines endorsed by the Royal College of Paediatrics and Child Health (RCPCH) have been developed. Here, I review recent high-profile court cases to underscore the changing landscape of conflict and the central role that the media (and social media in particular) can play in fuelling and intensifying conflicts. The CMF and RCPCH-endorsed guidelines are discussed in the context of my own experience utilising some of these, as well as implementing other strategies aimed at reducing conflict in a paediatric oncology and haematology unit.
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Affiliation(s)
- Nicholas G Gottardo
- Department of Paediatric and Adolescent Oncology/Haematology, Perth Children's Hospital, Nedlands, Western Australia, Australia .,Brain Tumour Research Programme, Telethon Kids Institute, Nedlands, Western Australia, Australia.,School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
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Castor C, Hallström IK, Landgren K, Hansson H. Accessibility, utilisation and acceptability of a county-based home care service for sick children in Sweden. Scand J Caring Sci 2019; 33:824-832. [PMID: 30865330 PMCID: PMC7432181 DOI: 10.1111/scs.12678] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/10/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Home care service (HCS) for sick children is a complex healthcare service, which can be organised in various models. Despite the possibility to support family everyday life, the accessibility and utilisation may still be limited. The aim of this study was to (i) determine characteristics in referrals to county-based HCS, (ii) determine characteristics of referred children and (iii) assess acceptability of parents and children in county-based HCS. METHODS Data on characteristics of referrals and referred children were collected from medical records of children 0-17 years of age, referred to eight HCS units during 2015-2018. Data on parental and child overall experience, satisfaction of, safety with, and preference for care, were collected from parents by a questionnaire. Descriptive and comparative statistics were used to analyse the data. RESULTS Three hundred and fifty-five referrals led to one or more periods of HCS for 171 children in various ages with a wide range of illnesses. Children with cancer (30%) composed the largest group and administration of intravenous antibiotics accounted for 56% of the care tasks. Seven per cent of the referrals were to palliative home care. Thirty-eight referrals of 34 children were refused. There was an uneven distribution of the indication for referral, acceptance rate and diagnoses of children among HCS units. Parents reported their and their child's experience with the HCS visit as highly positive and preferred home care to hospital care in over 96% of the HCS in 212 visits. CONCLUSION County-based HCS constitutes a supplement to hospital care for sick children with various illnesses through different stages of acute and long-term illness and at end of life, with high levels of acceptability. Few referrals and variation in referral characteristics and acceptance rate of referrals between HCS units led to unequal and inequitable accessibility and utilisation of HCS.
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Affiliation(s)
- Charlotte Castor
- Department of Health SciencesFaculty of MedicineLund UniversityLundSweden
| | | | - Kajsa Landgren
- Department of Health SciencesFaculty of MedicineLund UniversityLundSweden
| | - Helena Hansson
- Paediatrics and Adolescent MedicineCopenhagen University Hospital RigshospitaletKøbenhavn ØDenmark
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Yu J, Song IG, Kim CH, Moon YJ, Shin HY, Kim MS. Perceptions of Pediatric Palliative Care among Physicians Who Care for Pediatric Patients in South Korea. J Palliat Med 2019; 23:346-352. [PMID: 31580756 DOI: 10.1089/jpm.2018.0584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Despite advances in medical technology, resources for pediatric palliative care (PPC) for children with serious illnesses are limited in South Korea. Physicians' awareness of and willingness to provide general palliative care and refer to specialized palliative care are key elements for providing PPC. Objective: The aim of this study was to explore physicians' perceptions of PPC and the differences therein between nononcologists and oncologists. Design: A nationwide survey was conducted among physicians caring for children in 45 tertiary hospitals in South Korea. Measurements: A questionnaire was developed to identify the confidence in and need for PPC, appropriate timing for PPC referrals, and perceived barriers to PPC. Results: Overall, 141 physicians responded (response rate: 10.4%). Physicians' confidence in PPC was low, although most reported a high need for PPC. Lack of workforce and facilities specialized in PPC (60.2%) and patients' or caregivers' negative recognition (55.9%) were reported as the main barriers to PPC implementation. Specialized PPC services in children's hospitals were preferred as the model of care (84.2%). Compared with nononcologists, oncologists showed higher confidence levels in decision making and communication with patients and families with poor prognosis (p = 0.041) and education and providing end-of-life care (p < 0.001). Furthermore, oncologists preferred earlier referrals than did nononcologists. Conclusions: To promote PPC provision and improve the quality of life of pediatric patients and their families, it is important to introduce PPC early into disease-modifying treatment at any level of health care. Developing education and training curricula regarding PPC for health care providers caring for children with severe illnesses is crucial.
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Affiliation(s)
- Juyoun Yu
- Department of Nursing, Suwon Women's University, Suwon, Korea
| | | | - Cho Hee Kim
- College of Nursing, Seoul National University, Seoul, Korea
| | - Yi Ji Moon
- Seoul National University Hospital, Seoul, Korea
| | | | - Min Sun Kim
- Seoul National University Hospital, Seoul, Korea
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Sidgwick P, Fraser J, Fortune PM, McCulloch R. Parallel planning and the paediatric critical care patient. Arch Dis Child 2019; 104:994-997. [PMID: 30705081 DOI: 10.1136/archdischild-2018-315222] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 12/02/2018] [Accepted: 12/21/2018] [Indexed: 11/03/2022]
Abstract
A growing number of children with life-limiting conditions (LLCs) are being cared for in paediatric critical care (PCC) settings. Children with LLCs admitted to PCC are at a high risk of developing complications and many die after prolonged admissions. Relatively few of these patients and their parents or carers have had documented discussions about their wishes for care in the event of a serious clinical deterioration before admission to PCC. There is a need for improved understanding of (1) how parents arrive at decisions regarding what is best for their child at times of critical illness and (2) the role of parallel planning and advance care plans in that process. This review examines the complexities of decision-making in children with LLCs who are admitted to PCC settings.
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Affiliation(s)
- Peter Sidgwick
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK
| | - James Fraser
- Paediatric Intensive Care Unit, Bristol Children's Hospital, Bristol, UK
| | - Peter-Marc Fortune
- Paediatric Intensive Care Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - Renee McCulloch
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital, London, UK
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Rost M, De Clercq E, Rakic M, Wangmo T, Elger B. Barriers to Palliative Care in Pediatric Oncology in Switzerland: A Focus Group Study. J Pediatr Oncol Nurs 2019; 37:35-45. [DOI: 10.1177/1043454219871082] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: For children with cancer, early integration of pediatric palliative care in conjunction with curative treatments is recommended. In Switzerland, pediatric palliative care is mostly provided by an interdisciplinary primary oncology team that is mainly composed of nurses. However, only a small fraction of children receive pediatric palliative care and only a minority of them in a timely manner. The main aim was to identify barriers to the provision of pediatric palliative care in Swiss pediatric oncology. Method: This qualitative study consisted of five focus groups. In total, 29 pediatric oncology providers participated (13 nurses, 11 physicians, 4 psycho-oncologists, 1 social worker). Data were analyzed employing applied thematic analysis. Results: Analysis revealed eleven barriers: lack of financial resources, lack of prejob education regarding pediatric palliative care, lack of awareness in politics and policy making, absence of a well-established nationwide bridging care system, insufficient psychosocial and professional supervision for staff, understaffing, inadequate infrastructure of hospitals, asymmetry of factual and emotional knowledge between parents and providers, cultural aspects, irrational parental hopes, and “the unspoken.” Discussion: Awareness should be raised for pediatric palliative care (in particular in demarcation from palliative care in adults) among politics and policy makers which could lead to increased financial resources that, in turn, could be used to improve bridging care, hospital’s infrastructure, and team support. More flexibility for care determining factors is needed, for example, with respect to convening team meetings, short-termed staffing, and reimbursement at the interface between inpatient and outpatient services.
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De Clercq E, Rost M, Rakic M, Ansari M, Brazzola P, Wangmo T, Elger BS. The conceptual understanding of pediatric palliative care: a Swiss healthcare perspective. BMC Palliat Care 2019; 18:55. [PMID: 31296209 PMCID: PMC6625075 DOI: 10.1186/s12904-019-0438-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 06/24/2019] [Indexed: 12/31/2022] Open
Abstract
Background Health care providers’ perception of pediatric palliative care might negatively influence timely implementation. The aim of the study was to examine understanding of and attitudes towards pediatric palliative care from the perspective of health care providers working in pediatric oncology in Switzerland to promote the timely implementation of pediatric palliative care. Methods Five mixed focus groups were conducted with 29 health care providers (oncologists, nurses, psychologists, and social workers) at five Swiss pediatric oncology group centers. The focus group interviews were analyzed using thematic coding. Results Most participants associated pediatric palliative care with non-curative treatment. They regularly reported difficulties in addressing palliative care services to families due to the strong stigma surrounding this term. They also thought that the notion of palliative care is very much linked to a policy context, and difficult to reconcile with children’s everyday life. To overcome these obstacles many participants used synonyms such as comfort or supportive care. A few providers insisted on the need of using palliative care and reported the importance of positive “word of mouth”. Conclusions The use of synonyms might be a pragmatic approach to overcome initial barriers to the implementation of palliative care in pediatrics. However, this tactic might ultimately prove to be ineffective as these terms might acquire the same negative connotations as palliative care. Positive word-of-mouth by satisfied families and healthcare providers might be a more sustainable way to advocate for pediatric palliative care than replacing it with a euphemistic term.
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Affiliation(s)
- Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Basel, Switzerland.
| | - Michael Rost
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Basel, Switzerland
| | - Milenko Rakic
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Basel, Switzerland
| | - Marc Ansari
- Division of General Pediatrics Pediatric Oncohematology Unit, Hopitaux Universitaires de Geneve Hopital des enfants, Rue Willy Donzé 6, 1205, Geneva, Switzerland
| | - Pierluigi Brazzola
- Ospedale Regionale di Bellinzona e Valli, Pediatria Bellinzona, Via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Basel, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Basel, Switzerland
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Dunbar H, Carter B, Brown J. Coming ‘Home’: Place bonding for parents accessing or considering hospice based respite. Health Place 2019; 57:101-106. [DOI: 10.1016/j.healthplace.2019.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/19/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
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Revon-Rivière G, Pauly V, Baumstarck K, Bernard C, André N, Gentet JC, Seyler C, Fond G, Orleans V, Michel G, Auquier P, Boyer L. High-intensity end-of-life care among children, adolescents, and young adults with cancer who die in the hospital: A population-based study from the French national hospital database. Cancer 2019; 125:2300-2308. [PMID: 30913309 DOI: 10.1002/cncr.32035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/17/2018] [Accepted: 01/25/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Efforts to improve the quality of end-of-life (EOL) care depend on better knowledge of the care that children, adolescents, and young adults with cancer receive, including high-intensity EOL (HI-EOL) care. The objective was to assess the rates of HI-EOL care in this population and to determine patient- and hospital-related predictors of HI-EOL from the French national hospital database. METHODS This was a population-based, retrospective study of a cohort of patients aged 0 to 25 years at the time of death who died at hospital as a result of cancer in France between 2014 and 2016. The primary outcome was HI-EOL care, defined as the occurrence of ≥1 chemotherapy session <14 days from death, receiving care in an intensive care unit ≥1 time, >1 emergency room admission, and >1 hospitalization in an acute care unit in the last 30 days of life. RESULTS The study included 1899 individuals from 345 hospitals; 61.4% experienced HI-EOL care. HI-EOL was increased with social disadvantage (adjusted odds ratio [AOR], 1.30; 95% confidence interval [CI], 1.03-1.65; P = .028), hematological malignancies (AOR, 2.09; 95% CI, 1.57-2.77; P < .001), complex chronic conditions (AOR, 1.60; 95% CI, 1.23-2.09; P = .001) and care delivered in a specialty center (AOR, 1.70; 95% CI, 1.22-2.36; P = .001). HI-EOL was reduced in cases of palliative care (AOR, 0.31; 95% CI, 0.24-0.41; P < .001). CONCLUSION A majority of children, adolescents, and young adults experience HI-EOL care. Several features (eg, social disadvantage, cancer diagnosis, complex chronic conditions, and specialty center care) were associated with HI-EOL care. These findings should now be discussed with patients, families, and professionals to define the optimal EOL.
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Affiliation(s)
- Gabriel Revon-Rivière
- Department of Pediatric Hematology and Oncology, La Timone Children's Hospital, APHM, Marseille, France
- Fédération des Équipes Ressources Régionales de Soins Palliatifs Pédiatriques
| | - Vanessa Pauly
- Aix-Marseille University, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France
- Department of Medical Information, APHM, Marseille, France
| | - Karine Baumstarck
- Aix-Marseille University, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Cecile Bernard
- Aix-Marseille University, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Nicolas André
- Department of Pediatric Hematology and Oncology, La Timone Children's Hospital, APHM, Marseille, France
| | - Jean-Claude Gentet
- Department of Pediatric Hematology and Oncology, La Timone Children's Hospital, APHM, Marseille, France
| | | | - Guillaume Fond
- Aix-Marseille University, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France
- Department of Medical Information, APHM, Marseille, France
| | | | - Gérard Michel
- Department of Pediatric Hematology and Oncology, La Timone Children's Hospital, APHM, Marseille, France
- Aix-Marseille University, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Pascal Auquier
- Aix-Marseille University, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Laurent Boyer
- Aix-Marseille University, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France
- Department of Medical Information, APHM, Marseille, France
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Cheng BT, Rost M, De Clercq E, Arnold L, Elger BS, Wangmo T. Palliative care initiation in pediatric oncology patients: A systematic review. Cancer Med 2018; 8:3-12. [PMID: 30525302 PMCID: PMC6346252 DOI: 10.1002/cam4.1907] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/06/2018] [Accepted: 11/08/2018] [Indexed: 02/06/2023] Open
Abstract
Palliative care (PC) aims to improve quality of life for patients and their families. The World Health Organization and American Academy of Pediatrics recommend that PC starts at diagnosis for children with cancer. This systematic review describes studies that reported PC timing in the pediatric oncology population. The following databases were searched: PubMed, Web of Science, CINAHL, and PsycInfo databases. Studies that reported time of PC initiation were independently screened and reviewed by 2 researchers. Studies describing pilot initiatives, published prior to 1998, not written in English, or providing no empirical time information on PC were excluded. Extracted data included sample characteristics and timing of PC discussion and initiation. Of 1120 identified citations, 16 articles met the inclusion criteria and comprised the study cohort. Overall, 54.5% of pediatric oncology patients received any palliative service prior to death. Data revealed PC discussion does not occur until late in the illness trajectory, and PC does not begin until close to time of death. Despite efforts to spur earlier initiation, many pediatric oncology patients do not receive any palliative care service, and those who do, predominantly receive it near the time of death. Delays occur both at first PC discussion and at PC initiation. Efforts for early PC integration must recognize the complex determinants of PC utilization across the illness timeline. This systematic review examines the timing of palliative care initiation in pediatric oncology patients to assess the state of palliative care integration. Many pediatric oncology patients do not receive any palliative service, and those who do, typically receive it late in the illness trajectory.
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Affiliation(s)
- Brian T Cheng
- Department of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael Rost
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Louisa Arnold
- Institute of Psychology, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Renton K, Mayer APT, Alison L, Yeomanson D. Factors associated with place of death for children in South Yorkshire: a retrospective cohort study. BMJ Support Palliat Care 2018; 10:e10. [PMID: 30446488 DOI: 10.1136/bmjspcare-2018-001584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/09/2018] [Accepted: 10/24/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Place of death (POD) is considered a key quality indicator for adult end of-life care, but paediatric evidence is limited. Data from Child Death Overview Panel (CDOP) databases provides an opportunity to describe trends in POD as regional paediatric palliative medicine (PPM) options have increased. Aims were to identify and describe trends in POD for children in South Yorkshire. METHODS Retrospective cohort study. Anonymised data extracted from five CDOP databases 2008-2015. Data included age, gender, ethnicity, postcode (outward code only), POD, classification and category of death. Descriptive statistical analysis using χ2 test was used to assess intergroup differences. RESULTS 748 deaths were notified from 2008 to 2015. Neonatal deaths were excluded, 46% (n=345). Of non-neonatal deaths (n=403), 58% (n=232) were 'expected'. Of expected deaths (n=232), 19% (n=45) died in home, 19% (n=45) died in hospice and 61% (n=141) died in hospital. This was significantly different from comparable national data which showed considerably more hospital deaths. There was no significant change in POD over time. CONCLUSION Hospital remains the POD for most children, whether deaths are 'expected' or not, suggesting specialised PPM should be expanded into the hospital setting. More research is needed regarding preference for POD. This study may help inform future service planning for PPM and hospice development.
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Affiliation(s)
- Kate Renton
- Paediatric Palliative Medicine, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | | | - Lilias Alison
- Child Assessment Unit, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Daniel Yeomanson
- Paediatric Oncology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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Pentaris P, Papadatou D, Jones A, Hosang GM. Palliative care professional's perceptions of barriers and challenges to accessing children's hospice and palliative care services in South East London: A preliminary study. DEATH STUDIES 2018; 42:649-657. [PMID: 29393840 DOI: 10.1080/07481187.2018.1430081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Several barriers have been identified as preventing or delaying access to children's palliative care services. The aim of this study is to further explore such barriers from palliative care professionals' perspective from two London boroughs. METHODS Qualitative-five children's palliative care professionals' perceptions were obtained from semi-structured interviews. RESULTS Three themes emerged: availability and adequacy of child palliative care (e.g., unreliability of services), obstacles to accessing palliative care (e.g., logistical challenges), and cultural values and family priorities. CONCLUSION These findings contribute to the equal opportunities dialogue in this sector and the need for future research to address the challenges identified.
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Affiliation(s)
- Panagiotis Pentaris
- a Department of Psychology, Social Work and Counselling , University of Greenwich , London , UK
- b Faiths and Civil Society Unit, Goldsmiths , University of London , London , UK
| | - Danai Papadatou
- c Department of Nursing , National and Kapodistrian University of Athens , Athens , Greece
| | - Alice Jones
- d Department of Psychology, Goldsmiths , University of London , London , UK
| | - Georgina M Hosang
- e Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary , University of London , London , UK
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Dunbar H, Carter B, Brown J. 'Place bonding' in children's hospice care: a qualitative study. BMJ Support Palliat Care 2018; 10:e25. [PMID: 30108042 DOI: 10.1136/bmjspcare-2018-001543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/18/2018] [Accepted: 07/25/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Limited knowledge exists of parents' perceptions and experiences of children's hospices and how these contribute to the varied access and uptake of services. AIM This study aimed to explore parents' perspectives and experiences of a hospice, to understand the barriers and/or facilitators to accessing a hospice, and what characteristics parents wanted from hospice provision. METHODS A two-phase qualitative study underpinned by a constructivist grounded theory methodology was employed. Phase 1 used focus groups to collect data from parents of children already accessing the hospice (n=24). Phase 2 used in-depth semistructured interviews with parents of children who did not use the hospice (n=7) and with parents who had previous experience of using a hospice (n=7). RESULTS A grounded theory of place bonding was developed which illustrates the cognitive journey taken by parents of children with life-limiting conditions considering/receiving hospice care for their child. CONCLUSIONS Finding a place where they belonged and felt at 'home' made the decision to accept help in caring for their child with a life-limiting condition more acceptable. The theory of place bonding offers children's hospices a new perspective from which to view how parents access, accept and build relationships at the hospice.
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Affiliation(s)
- Helena Dunbar
- Leicester School of Nursing and Midwifery, De Montfort University, Leicester, UK
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Supporting Parent Caregivers of Children with Life-Limiting Illness. CHILDREN-BASEL 2018; 5:children5070085. [PMID: 29949926 PMCID: PMC6069074 DOI: 10.3390/children5070085] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/20/2018] [Indexed: 11/17/2022]
Abstract
The well-being of parents is essential to the well-being of children with life-limiting illness. Parents are vulnerable to a range of negative financial, physical, and psychosocial issues due to caregiving tasks and other stressors related to the illness of their child. Pediatric palliative care practitioners provide good care to children by supporting their parents in decision-making and difficult conversations, by managing pain and other symptoms in the ill child, and by addressing parent and family needs for care coordination, respite, bereavement, and social and emotional support. No matter the design or setting of a pediatric palliative care team, practitioners can seek to provide for parent needs by referral or intervention by the care team.
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Mitchell S, Slowther AM, Coad J, Dale J. The journey through care: study protocol for a longitudinal qualitative interview study to investigate the healthcare experiences and preferences of children and young people with life-limiting and life-threatening conditions and their families in the West Midlands, UK. BMJ Open 2018; 8:e018266. [PMID: 29358429 PMCID: PMC5780714 DOI: 10.1136/bmjopen-2017-018266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The number of children and young people living with life-limiting and life-threatening conditions is rising. Providing high-quality, responsive healthcare for them and for their families presents a significant challenge. Their conditions are often complex and highly unpredictable. Palliative care is advocated for people with life-limiting and life-threatening conditions, but these services for children are highly variable in terms of availability and scope. Little is known about the lived experiences and preferences of children and their families in terms of the palliative care that they do, or do not, receive. This study aims to produce an in-depth insight into the experiences and preferences of such children and families in order to develop recommendations for the future provision of services. The study will be carried out in the West Midlands, UK. METHODS AND ANALYSIS A qualitative study comprising longitudinal interviews over a 12-month period with children (aged 5-18 years) living with life-limiting or life-threatening conditions and their family members. Data analysis will start with thematic analysis, followed by narrative and cross-case analysis to examine changing experiences and preferences over time, at the family level and within the wider healthcare system. Patient and public involvement (PPI) has informed the design and conduct of the study. Findings will be used to develop recommendations for an integrated model of palliative care for children in partnership with the patient and public involvement (PPI) group. ETHICS AND DISSEMINATION Ethical approval was granted in September 2016 by the National Health Service Health Research Authority (IRAS ID: 196816, REC reference: 16/WM/0272). Findings will be of immediate relevance to healthcare providers, policy-makers, commissioners and voluntary sector organisations in the UK and internationally. Reports will be prepared for these audiences, as well as for children and their families, alongside academic outputs.
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Affiliation(s)
- Sarah Mitchell
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Jane Coad
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
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Mitchell S, Morris A, Bennett K, Sajid L, Dale J. Specialist paediatric palliative care services: what are the benefits? Arch Dis Child 2017; 102:923-929. [PMID: 28377450 DOI: 10.1136/archdischild-2016-312026] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 02/03/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND The number of children and young people (CYP) living with life-limiting and life-threatening conditions is rising. Paediatric palliative care is a relatively new aspect of healthcare, the delivery of which is variable, with a wide range of healthcare and voluntary sector providers involved. Policy recommendations are for Specialist Paediatric Palliative Care (SPPC) services to be supported by a physician with specialist training. AIM To examine the research evidence regarding the distinct benefits of SPPC services, with 'Specialist Paediatric Palliative Care' defined as palliative care services supported by a specialist physician. METHOD Systematic review of studies of SPPC services published in English from 1980 to 2016. Keyword searches were carried out in medical databases (Cochrane, PubMed, EMBASE, CINAHL and AMED) and a narrative synthesis. RESULTS Eight studies were identified, most of which were retrospective surveys undertaken within single institutions; three were surveys of bereaved parents and three were medical notes reviews. Together they represented a heterogeneous body of low-level evidence. Cross-cutting themes suggest that SPPC services improve the quality of life and symptom control and can impact positively on place of care and family support. CONCLUSIONS Current evidence indicates that SPPC services contribute beneficially to the care and experience of CYP and their families, but is limited in terms of quantity, methodological rigour and generalisability. Further research is necessary given the significant workforce and resource implications associated with policy recommendations about the future provision of SPPC and to address the need for evidence to inform the design and delivery of SPPC services.
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Affiliation(s)
- Sarah Mitchell
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Morris
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Karina Bennett
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Laiba Sajid
- Sibling Council, Acorns Children's Hospice Trust, Birmingham, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
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Pediatric Cardiology Provider Attitudes About Palliative Care: A Multicenter Survey Study. Pediatr Cardiol 2017; 38:1324-1331. [PMID: 28664445 DOI: 10.1007/s00246-017-1663-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/15/2017] [Indexed: 02/07/2023]
Abstract
While availability of palliative care consultation for children with advanced heart disease increases, little is known about cardiologist attitudes towards palliative care. We sought to describe perspectives of cardiologists regarding palliative care and to characterize their perceived competence in palliative care concepts. A cross-sectional survey of pediatric cardiologists and cardiac surgeons from 19 pediatric medical centers was performed. Overall response rate was 31% (183/589). Respondents had a median of 18 years of experience since medical school (range 2-49) and most practiced at academic centers (91%). Sixty-percent of respondents felt that palliative care consultations occur "too late" and the majority (85%) agreed that palliative care consultations are helpful. Barriers to requesting palliative care consultation were most frequently described as "referring to palliative care services too early will undermine parents' hope" (45%) and "concern that parents will think I am giving up on their child" (56%). Only 33% of cardiologists reported feeling "very" or "moderately" competent in prognosticating life expectancy while over 60% felt competent caring for children with heart disease around end of life, and nearly 80% felt competent discussing goals of care and code status. Greater perceived competence was associated with subspecialty (heart failure/intensivist vs. other) (OR 3.6, 95% CI 1.6-8.1, p = 0.003) and didactic training (OR 6.27, 95% CI 1.8-21.8, p = 0.004). These results underscore the need for further training in palliative care skills for pediatric cardiologists. Enhancing palliative care skills among cardiologists and facilitating partnership with subspecialty palliative care teams may improve overall care of children with advanced heart disease.
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Aligning guidelines and medical practice: Literature review on pediatric palliative care guidelines. Palliat Support Care 2017; 15:474-489. [PMID: 28065197 DOI: 10.1017/s1478951516000882] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Palliative care for children is becoming an important subspecialty of healthcare. Although concurrent administration of curative and palliative care is recommended, timely referral to pediatric palliative care (PPC) services remains problematic. This literature review aims to identify barriers and recommendations for proper implementation of palliative care for children through the looking glass of PPC guidelines. METHOD To identify studies on PPC guidelines, five databases were searched systematically between 1960 and 2015: Scopus, PubMed, PsycINFO, the Web of Science, and CINAHL. No restrictions were placed on the type of methodology employed in the studies. RESULTS Concerning barriers, most of the papers focused on gaps within medical practice and the lack of evidence-based research. Common recommendations therefore included: training and education of healthcare staff, formation of a multidisciplinary PPC team, research on the benefits of PPC, and raising awareness about PPC. A small number of publications reported on the absence of clear guidance in PPC documents regarding bereavement care, as well as on the difficulties and challenges involved in multidisciplinary care teams. SIGNIFICANCE OF RESULTS Our results indicate that a critical assessment of both the research guidelines and medical practice is required in order to promote timely implementation of PPC for pediatric patients.
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Di Guglielmo MD, Greenspan JS, Abatemarco DJ. Pediatrician preferences, local resources, and economic factors influence referral to a subspecialty access clinic. Prim Health Care Res Dev 2016; 17:628-635. [PMID: 27185320 PMCID: PMC5065399 DOI: 10.1017/s1463423616000165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Pediatric patients seek timely access to subspecialty care within a complex delivery system while facing barriers: distance, economics, and clinician shortages. Aim We examined stakeholder perceptions about solutions to the access challenge. We engaged over 300 referring primary care pediatricians in the evaluation of Access Clinics at an academic children's hospital. METHODS Using an anonymous online survey, we asked pediatricians about their and their patients' experiences and analyzed factors that may influence referrals. Findings Referring pediatricians reported satisfaction; they provided feedback about their patients' experiences, physician communication, and referral influences. Distance from the Access Clinic does not correlate with differences in referral volume; living in areas with higher child populations and higher median income is associated with more referrals. Referring pediatricians have strong opinions about referrals, are attuned to patient experiences, and desire bi-directional communication. Multiple factors influence referral to and acceptance of Access Clinics, but external influences have less impact than expected.
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Affiliation(s)
- Matthew D. Di Guglielmo
- Clinical Assistant Professor of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Jay S. Greenspan
- Professor of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Pediatrics, Nemours/Alfred I., duPont Hospital for Children, Wilmington, DE, USA
| | - Diane J. Abatemarco
- Associate Professor of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Pediatrics, Nemours/Alfred I., duPont Hospital for Children, Wilmington, DE, USA
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Bertaud S, Llovd DFA, Laddie J, Razavi R. The importance of early involvement of paediatric palliative care for patients with severe congenital heart disease. Arch Dis Child 2016; 101:984-7. [PMID: 27102758 PMCID: PMC7611378 DOI: 10.1136/archdischild-2015-309789] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 04/02/2016] [Indexed: 11/03/2022]
Abstract
Growing numbers of patients with severe congenital heart disease (CHD) are surviving into late childhood and beyond. This increasingly complex patient group may experience multiple formidable and precarious interventions, lifelong morbidity and the very real risk of premature death on many occasions throughout their childhood. In this paper, we discuss the advantages of a fully integrated palliative care ethos in patients with CHD, offering the potential for improved symptom control, more informed decision-making and enhanced support for patients and their families throughout their disease trajectory. These core principles may be delivered alongside expert cardiac care via non-specialists within pre-existing networks or via specialists in paediatric palliative care when appropriate. By broaching these complex issues early-even from the point of diagnosis-an individualised set of values can be established around not just end-of-life but also quality-of-life decisions, with clear benefits for patients and their families regardless of outcome.
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Affiliation(s)
- Sophie Bertaud
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, The Rayne Institute, St. Thomas’ Hospital, London, UK
| | - David F A Llovd
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, The Rayne Institute, St. Thomas’ Hospital, London, UK,Department of Paediatric Cardiology, Evelina London Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - Joanna Laddie
- Department of Paediatric Palliative Care, Evelina London Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, The Rayne Institute, St. Thomas’ Hospital, London, UK,Department of Paediatric Cardiology, Evelina London Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
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Mahmood LA, Casey D, Dolan JG, Dozier AM, Korones DN. Feasibility of Early Palliative Care Consultation for Children With High-Risk Malignancies. Pediatr Blood Cancer 2016; 63:1419-22. [PMID: 27148856 DOI: 10.1002/pbc.26024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/18/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Children with cancer suffer significant morbidity throughout therapy and often face an uncertain prognosis. Because palliative care teams can provide an additional layer of support with symptom management and communication, we conducted a prospective study assessing the feasibility of early palliative care consultation for children with high-risk malignancies. PROCEDURE This study was part of a larger prospective study examining the impact of early palliative care consultation. Children were eligible if they were <22 years old and had a high-risk malignancy, recurrence, or required hematopoietic stem cell transplantation (HSCT). Data were collected from the medical record on diagnosis, days to consultation, acceptability of consultation to family/staff, and overall survival. Feasibility was defined as enrollment of >75% of eligible patients, palliative care consultation within 1 month of eligibility, and patient/family satisfaction. RESULTS Twenty of 25 (80%) eligible patients were approached and received a palliative care consultation at initial diagnosis (7), recurrence (12), or time of HSCT (1). Median age of the children was 5 years (0.1-20 years). Median time from new diagnosis/recurrence to consultation was 12 days (2-180 days); 17 (85%) received the consultation within 30 days. Eleven (55%) of the 20 children died. Median time of consultation prior to death was 128 days (10-648 days). Ten of the 11 (91%) received their consultation >30 days prior to death. No families or oncologists declined an early consultation. CONCLUSIONS Early palliative care consultation is feasible for children with high-risk cancer and is acceptable to children, families, and pediatric oncologists.
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Affiliation(s)
- Laila A Mahmood
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Denise Casey
- Office of Hematology and Oncology Products, Food and Drug Administration
| | - James G Dolan
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Ann M Dozier
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - David N Korones
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
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Carr EC, Briggs EV, Briggs M, Allcock N, Black P, Jones D. Understanding factors that facilitate the inclusion of pain education in undergraduate curricula: Perspectives from a UK survey. Br J Pain 2016; 10:100-7. [PMID: 27551420 DOI: 10.1177/2049463716634377] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Studies in Europe, North America and Australasia suggest that one in five adults suffer from pain. There is increasing recognition that pain, particularly chronic pain, represents a global health burden. Many studies, including two national surveys exploring the content of undergraduate curricula for pain education, identify that documented pain education in curricula was limited and fragmentary. METHODS The study design used a questionnaire which included an open text comment box for respondents to add 'further comments' as part of larger study previously published. The sample consisted of 19 UK universities that offered 108 undergraduate programmes in the following: dentistry, medicine, midwifery, nursing (adult, child, learning disabilities and mental health branches), occupational therapy (OT), pharmacy, physiotherapy and veterinary science. An inductive content analysis was performed, and the data were managed using NVivo 10 software for data management. RESULTS A total of 57 participants across seven disciplines (dentistry, medicine, midwifery, nursing, pharmacy, physiotherapy and OT) completed the open text comment box (none were received from veterinary science). Analysis revealed two major themes of successes and challenges. Successes included expansion (extending coverage and/or increased student access), multidimensional curriculum content and diversity of teaching methods. Challenges included difficulties in identifying where pain is taught in the curriculum, biomedical versus biopsychosocial definitions of pain, perceived importance, time, resources and staff knowledge, and finally a diffusion of responsibility for pain education. CONCLUSION This study identifies new insights of the factors attributed to successful implementation of pain education in undergraduate education. Many of the challenges previously reported were also identified. This is one of the first studies to identify a broad range of approaches, for pain education, that could be deemed as 'successful' across a range of health disciplines.
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Affiliation(s)
- Eloise Cj Carr
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Emma V Briggs
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
| | - Michelle Briggs
- Centre for Pain Research, Queens Square House, Leeds Metropolitan University, Leeds, UK
| | | | - Pauline Black
- School of Nursing, Ulster University, Londonderry, UK
| | - Derek Jones
- NMAHP Research Unit, Stirling University Innovation Park, Stirling, UK
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Wong A, Reddy A, Williams JL, Wu J, Liu D, Bruera E, Wong A, Reddy A, Williams JL, Wu J, Liu D, Bruera E. ReCAP: Attitudes, Beliefs, and Awareness of Graduate Medical Education Trainees Regarding Palliative Care at a Comprehensive Cancer Center. J Oncol Pract 2016; 12:149-50; e127-37. [PMID: 26787756 PMCID: PMC5702790 DOI: 10.1200/jop.2015.006619] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Palliative care (PC) training and integration with oncology care remain suboptimal. Current attitudes and beliefs of the oncology trainees regarding PC are not fully known. This study was undertaken in an attempt to address this issue. PARTICIPANTS AND METHODS We conducted a survey to determine awareness of PC among graduate medical trainees at a comprehensive cancer center with an established PC program. One hundred seventy oncology trainees who completed$9 months of training in medical, surgical, gynecologic, and radiation oncology fellowships and residency programs during the 2013 academic year completed an online questionnaire. Descriptive, univariable, and multivariable analyses were performed. RESULTS The response rate was 78% (132 of 170 trainees); 10 trainees without hands-on patient care were excluded. Medical (53 of 60 [88%]), gynecologic (six of six [100%]), and radiation oncology (20 of 20 [100%]) trainees reported more awareness of PC compared with surgical oncology (22 of 36 [61%]) trainees (P = .001). One hundred twelve of 122 (92%) perceived PC as beneficial to patients and families. One hundred eight of 122 (89%) perceived that PC can reduce health care costs, 78 (64%) believed that PC can increase survival, and 90 (74%) would consult PC for a patient with newly diagnosed cancer with symptoms. Eighty-two trainees (67%) believed a mandatory PC rotation is important. Trainees with previous exposure to PC rotations were more aware of the role of PC services than were trainees without PC rotation (96% [46 of 48] v 74% [55 of 74]; P = .005, respectively). CONCLUSION Surgical trainees and trainees without previous PC rotation had significantly less awareness of PC. Overall, trainees perceived PC as beneficial to patients and capable of reducing costs while increasing survival; they also supported early PC referrals and endorsed a mandatory PC rotation.
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Affiliation(s)
| | - Akhila Reddy
- The University of Texas MD Anderson Cancer Center
| | | | - Jimin Wu
- The University of Texas MD Anderson Cancer Center
| | - Diane Liu
- The University of Texas MD Anderson Cancer Center
| | | | - Angelique Wong
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Akhila Reddy
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jimin Wu
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Diane Liu
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- The University of Texas MD Anderson Cancer Center, Houston, TX.
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Bergstraesser E, Paul M, Rufibach K, Hain RD, Held L. The Paediatric Palliative Screening Scale: Further validity testing. Palliat Med 2014; 28:530-533. [PMID: 24280277 DOI: 10.1177/0269216313512886] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Paediatric palliative care is still often introduced late in the illness trajectory of children with life-limiting diseases. Translating palliative care into practice continues to be a challenge. AIM To validate the Paediatric Palliative Screening Scale further by defining attributes that predict the need for palliative care in children between 1 and 18 years. DESIGN Proportional-odds logistic regression analysis was performed to investigate the relationship between the attributes of the Paediatric Palliative Screening Scale and the experts' assessment of case vignettes with various combinations of different attribute characteristics. Estimates from regression analysis were transformed to empirical weightings of the Paediatric Palliative Screening Scale attribute characteristics. SETTING/PARTICIPANTS Online questionnaires with case vignettes were sent to 33 paediatric palliative care experts from Europe, the United States, Canada, Australia and New Zealand. RESULTS The highest weightings among the five previously defined attributes were estimated life expectancy <12 months (40% of maximum score) and preferences of the child/parents received (24%). Trajectory of disease and impact on daily activities of the child, expected outcome of treatment directed at the disease and burden of treatment, and symptom or problem burden were weighted less. CONCLUSIONS According to this second step of psychometric testing of the Paediatric Palliative Screening Scale, the strongest and most urgent necessity indicators for a palliative care approach are life expectancy and child/family preferences. These results are somewhat discrepant with results from the previous validation of the instrument as well as previous research findings.
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Affiliation(s)
- Eva Bergstraesser
- 1 Department of Palliative Care and Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Michaela Paul
- 2 Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Kaspar Rufibach
- 2 Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Richard D Hain
- 3 Paediatric Palliative Care, Children's Hospital, Cardiff, UK
| | - Leonhard Held
- 2 Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
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Abstract
Specialist paediatric palliative care is a relatively new area of paediatrics, and the interface with other disciplines can occasionally pose challenges for referrers due to lack of information about the diverse services available. Although services vary on a regional basis, there are common principles which may be used to guide and support referrals. Children may be referred to palliative care services via a number of routes from community-based primary care to regional tertiary centres. Identifying those most likely to benefit from the finite resources available can be a challenge, and healthcare professional's negative attitudes to palliative care have been further identified as a potentially modifiable barrier. This article aims to clarify the role of specialist paediatric palliative care, identify who should be eligible for such care, describe the services available (including those from children's hospices) and provide a tool for assessing some of the most challenging referrals. Many of the documents referenced can be downloaded from the Together for Short Lives website, and in many cases, there is no charge.
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Affiliation(s)
- Emily Harrop
- Paediatric Palliative Care, Helen & Douglas House Hospices, , Oxford, UK
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