1
|
Holmen H, Winger A, Steindal SA, Riiser K, Castor C, Kvarme LG, Mariussen KL, Lee A. Patient-reported outcome measures in children, adolescents, and young adults with palliative care needs-a scoping review. BMC Palliat Care 2023; 22:148. [PMID: 37798706 PMCID: PMC10557323 DOI: 10.1186/s12904-023-01271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Measuring outcomes facilitates evaluation of palliative services for children, adolescents, and young adults (CAYAs) with life-limiting and/or life-threatening (LL/LT) conditions. Implementation of patient-reported, proxy-reported, or patient-centered outcome measures (hereafter PROMs) is recommended to ensure palliative services. The purpose of this scoping review was to provide an overview of PROMs relevant for CAYAs living with LL/LT conditions eligible for pediatric palliative care (PPC). METHODS Arksey and O'Malley's 6-stage scoping review framework was used to guide the review. The identified citations had to report on PROMs in any context including CAYAs with LL/LT conditions up to 25 years of age. A systematic search of Medline, EMBASE, CINAHL, APA PsycInfo, Health and Psychosocial Instruments, and AMED took place in January 2021 and was updated in June 2022. Citations were screened independently by pairs of researchers. The scoping review protocol was registered, and peer-review published. RESULTS Of 3690 identified citations, 98 reports were included, of which the majority were from Western countries and about PROMs in CAYAs living with cancer or organ failure. A total of 80 PROMs were identified, assessing a range of phenomena, where quality of life and symptoms (especially pain) during the stage of ongoing care were the most frequent. There were only a few reports about outcome measures at time of diagnosis or in end-of-life care. CAYAs self-reported on the PROMs or collaborated with their parents in about half of the reports, while the remaining had proxies answering on behalf of the CAYAs. In the identified reports, PROMs were used to characterize a sample through cross-sectional or longitudinal research, and less often to assess effects of interventions. CONCLUSION The identified PROMs in the CAYA population eligible for PPC is characterized by studies in high-income countries during ongoing care, primarily in patients with cancer or organ failure. More research is needed in patients living with other LL/LT conditions, and during different stages of the disease course, especially at time of diagnosis, during transition to adulthood, and in end-of-life care. This scoping review of PROMs relevant for young patients eligible for PPC may inform future research about patient-/proxy-reported or patient-centered outcome measures in PPC. TRIAL REGISTRATION Review registration: ( https://osf.io/yfch2/ ) and published protocol (Holmen et al. Syst Rev. 10:237, 2021).
Collapse
Affiliation(s)
- Heidi Holmen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway.
| | - Anette Winger
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggt, 15B, 0456, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Kirsti Riiser
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway
| | - Charlotte Castor
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden
| | - Lisbeth Gravdal Kvarme
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway
| | - Kari L Mariussen
- Lovisenberg Diaconal University College, Lovisenberggt, 15B, 0456, Oslo, Norway
| | - Anja Lee
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital HF, Nydalen, Box 4950, 0424, Oslo, Norway
| |
Collapse
|
2
|
Palliative Care in the Delivery Room: Challenges and Recommendations. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010015. [PMID: 36670565 PMCID: PMC9856529 DOI: 10.3390/children10010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Palliative care in the delivery room is an interprofessional and interdisciplinary challenge addressing the dying newborn and parents as well as the caregivers. It differs in some significant aspects from palliative care in the neonatal intensive care unit. Clinical experience suggests that many details regarding this unique specialized palliative care environment are not well known, which may result in some degree of insecurity and emotional distress for health care providers. This article presents basic background information regarding the provision of palliative care to newborns within the delivery room. It offers orientation along with a preliminary set of practical recommendations regarding the following central issues: (i) the basic elements of perinatal palliative care, (ii) the range of non-pharmacological and pharmacological interventions available for infant symptom control near the end of life, (iii) meeting the personal psychological, emotional, and spiritual needs of the parents, and (iv) care and self-care for medical personnel.
Collapse
|
3
|
Pierron C, Levy M, Mattioni V, Poncelet G, Le Bourgeois F. Perceptible Signs of End of Life in Pediatric Intensive Care Patients. J Palliat Med 2022; 25:1829-1834. [PMID: 36137014 DOI: 10.1089/jpm.2021.0582] [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: 01/04/2023] Open
Abstract
Background: How children die in pediatric intensive care units (PICUs) has been poorly described, and support for parents during this traumatic experience could be improved. Better information on perceptible signs of the end of life (EOL) in children may help mitigate the trauma. Objective: To describe the most common perceptible EOL signs in PICU patients. Methods: A prospective study in a PICU. Health care providers observed 28 children expected to die and noted the perceptible signs. Results: The most common perceptible signs were desaturation and bradycardia. Twenty-seven patients had at least one change in physical appearance. Gasping was noted in 12 patients. Conclusion: Perceptible signs of the EOL were different from those reported in children dying in other units or in adults. Sharing information about signs of EOL with parents may prepare them and enable them to better support their child.
Collapse
Affiliation(s)
- Charlotte Pierron
- Neonatal and Pediatric Intensive Care Unit, Hospital Center of Luxembourg-KannerKlinik, Luxembourg, Luxembourg
| | - Michaël Levy
- Pediatric Intensive Care Unit, Robert-Debré University Hospital, Paris, France
| | - Violaine Mattioni
- Medical Oncology Department, Saint Louis University Hospital, Paris, France
| | - Géraldine Poncelet
- Pediatric Intensive Care Unit, Robert-Debré University Hospital, Paris, France
| | - Fleur Le Bourgeois
- Pediatric Intensive Care Unit, Robert-Debré University Hospital, Paris, France
| |
Collapse
|
4
|
de Noriega I, Martino Alba R, Herrero Velasco B, Madero López L, Lassaletta Á. Palliative care in pediatric patients with central nervous system cancer: Descriptive and comparative study. Palliat Support Care 2022; 21:1-8. [PMID: 35957581 DOI: 10.1017/s1478951522001043] [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: 11/07/2022]
Abstract
OBJECTIVES Data regarding the palliative needs of pediatric patients with central nervous system (CNS) cancer are scarce. We aimed to describe the attention provided by a pediatric palliative care (PPC) team to patients with CNS cancer and the differences in care compared to patients who did not receive PPC. METHOD This retrospective study was based on the clinical records of deceased patients with CNS cancer attended by a PPC team over 10 years, analyzing their trajectory and provision of PPC, including medical, psychological, social, and nursing interventions. Furthermore, we compared the last month of life care of deceased patients with CNS cancer in the same institution, based on whether they were attended by the PPC team. RESULTS Of 71 patients, 59 received PPC, with a median of 1.6 months (Interquartile range: 0.6-5.2) from referral to death. Home hospitalization was provided to 84.8%, nursing interventions were registered in 89.8%, psychological characteristics in 84.7%, and social interventions in 88.1%. The most common symptoms were pain, dyspnea, and constipation. When comparing patients from the same hospital who received PPC (n = 36) with those who did not (n = 12), the former spent fewer days in the hospital in their last month and last week (p < 0.01) and were more likely to die at home (50% vs. 0%; p < 0.01). SIGNIFICANCE OF RESULTS Patients with CNS cancer show various medical, social, and psychological needs during end-of-life care. Providing specific PPC interventions decreased the number of days spent at the hospital and increased the rate of death at home.
Collapse
Affiliation(s)
- Iñigo de Noriega
- Pediatric Palliative Care Unit, Hospital Infantil Universitario del Niño Jesús, Madrid, Spain
| | - Ricardo Martino Alba
- Pediatric Palliative Care Unit, Hospital Infantil Universitario del Niño Jesús, Madrid, Spain
| | - Blanca Herrero Velasco
- Department of Pediatric Oncology, Hospital Infantil Universitario del Niño Jesús, Madrid, Spain
| | - Luis Madero López
- Department of Pediatric Oncology, Hospital Infantil Universitario del Niño Jesús, Madrid, Spain
| | - Álvaro Lassaletta
- Department of Pediatric Oncology, Hospital Infantil Universitario del Niño Jesús, Madrid, Spain
| |
Collapse
|
5
|
Linebarger JS, Johnson V, Boss RD, Linebarger JS, Collura CA, Humphrey LM, Miller EG, Williams CSP, Rholl E, Ajayi T, Lord B, McCarty CL. Guidance for Pediatric End-of-Life Care. Pediatrics 2022; 149:186860. [PMID: 35490287 DOI: 10.1542/peds.2022-057011] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The final hours, days, and weeks in the life of a child or adolescent with serious illness are stressful for families, pediatricians, and other pediatric caregivers. This clinical report reviews essential elements of pediatric care for these patients and their families, establishing end-of-life care goals, anticipatory counseling about the dying process (expected signs or symptoms, code status, desired location of death), and engagement with palliative and hospice resources. This report also outlines postmortem tasks for the pediatric team, including staff debriefing and bereavement.
Collapse
Affiliation(s)
- Jennifer S Linebarger
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City, School of Medicine, Kansas City, Missouri
| | - Victoria Johnson
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Renee D Boss
- Department of Pediatrics, Johns Hopkins University School of Medicine, Berman Institute of Bioethics, Baltimore, Maryland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Soo JEJ, Chan MY, Bte Adb Rashid NAB, Bte Mohamad Yusri LI, Wynn YY, Noda M, Tewani K. Medication chart review at end of life of paediatric palliative patients. J Paediatr Child Health 2022; 58:392-396. [PMID: 34553811 DOI: 10.1111/jpc.15719] [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: 09/12/2020] [Revised: 02/18/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to review the use of medications in a paediatric palliative care (PPC) population during the last two weeks of life. METHODS This is a retrospective observational cohort study that included 50 consecutive patients who were referred to KK Hospital PPC service from 2011 to 2015. Those who died after two weeks from discharge date were excluded. Medication charts were reviewed and relevant data were extracted. RESULTS The study population included 42 patients and consists predominantly oncological and neurological diagnoses. The median number of medications used was 11.5. Ninety-five percent (40 out of 42) of study population required analgesia where 81% (34 out of 42) were opioid. There was prevalent use of antibiotics (86% of study population, 36 out of 42). Less frequently used medications included steroids, sedatives, laxatives and antiemetics (48%, 52%, 48% and 38% of study population respectively). CONCLUSION Significant number of medications was used in PPC during the last two weeks of life. Apart from significant use of analgesia, there is also notable use of antibiotics. Future directions in education such as prescription of laxatives with opioid are proposed.
Collapse
Affiliation(s)
| | - Mei Yoke Chan
- KK Women's and Children's Hospital, Singapore, Singapore
| | | | | | - Yi Yi Wynn
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Misa Noda
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Komal Tewani
- KK Women's and Children's Hospital, Singapore, Singapore
| |
Collapse
|
7
|
Noriega ÍD, García-Salido A, Martino R, Herrero B. Palliative home-based care to pediatric cancer patients: characteristics and healthcare delivered. Support Care Cancer 2021; 30:59-67. [PMID: 34228173 DOI: 10.1007/s00520-021-06412-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cancer patients constitute an important group in pediatric palliative care. Though the patients' home is the preferred place of care, little is known about the characteristics of patients attended by units that provide home assistance. Our objective is to describe the characteristics of cancer patients and healthcare delivered by a pediatric palliative care unit with a home hospitalization program. METHODS Retrospective study based on clinical records of deceased patients attended by the pediatric palliative care unit of Madrid over 10 years. Data collected included general characteristics, type of cancer, whether they received home assistance, place of death, healthcare delivered (hospitalizations, devices, oncological treatments…), and symptom prevalence. RESULTS After excluding 47 patients, the clinical records of 144 patients were analyzed. The median age at referral was 9.4 years (IQR: 5.6-14.1), 61.2% were males; 44.2% had solid non-CNS tumors, 35.4% CNS tumors, and 20.4% hematological malignancies; 137 received home care with 89 not requiring further hospital admissions and 70.1% dying at home. The median follow-up time was 1.6 months (IQR: 0.5-2.9). The most used devices were venous ports (71.4%) and oxygen (49.4%); 53.5% of the patients received oncological support therapies. The most common symptoms were pain (91.8%) dyspnea (49.0%) and fatigue (46.9%). CONCLUSIONS Home assistance was provided in a high number of patients, with a large proportion needing one or no hospital admissions and 70.1% of them dying at home. Further studies characterizing these patients and the factors which promote early access to palliative care are needed.
Collapse
Affiliation(s)
- Íñigo de Noriega
- Pediatric Palliative Care Unit, Hospital Infantil Universitario Niño Jesús, Av. Menéndez Pelayo 65, 28009, Madrid (Madrid), Spain.
| | - Alberto García-Salido
- Pediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid (Madrid), Spain
| | - Ricardo Martino
- Pediatric Palliative Care Unit, Hospital Infantil Universitario Niño Jesús, Av. Menéndez Pelayo 65, 28009, Madrid (Madrid), Spain
| | - Blanca Herrero
- Pediatric Oncology Unit, Hospital Infantil Universitario Niño Jesús, Madrid (Madrid), Spain
| |
Collapse
|
8
|
Blais S, Cohen-Gogo S, Gouache E, Guerrini-Rousseau L, Brethon B, Rahal I, Petit A, Raimondo G, Pellegrino B, Orbach D. End-of-life care in children and adolescents with cancer: perspectives from a French pediatric oncology care network. TUMORI JOURNAL 2021; 108:223-229. [PMID: 33940999 DOI: 10.1177/03008916211013384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In developed countries, cancer remains the leading cause of pediatric death from illness after the neonatal period. OBJECTIVE To describe the end-of-life care characteristics of children and adolescents with solid tumors (ST) or hematologic malignancies (HM) who died from tumor progression in the Île-de-France area. METHODS This is a regional, multicentric, retrospective review of medical files of all children and adolescents with cancer who died over a 1-year period. Extensive data from the last 3 months of life were collected. RESULTS A total of 99 eligible patients died at a median age of 9.8 years (range, 0.3-24 years). The most frequent terminal symptoms were pain (n = 86), fatigue (n = 84), dyspnea (n = 49), and anorexia (n = 41). Median number of medications per patient was 8 (range, 3-18). Patients required administration of opioids (n = 91), oxygen (n = 36), and/or sedation (n = 61). Decision for palliative care was present in all medical records and do-not-resuscitate orders in 90/99 cases. Symptom prevalence was comparable between children and adolescents with ST and HM. A wish regarding the place of death had been expressed for 64 patients and could be respected in 42 cases. Death occurred in hospital for 75 patients. CONCLUSIONS This study represents a large and informative cohort illustrating current pediatric palliative care approaches in pediatric oncology. End-of-life remains an active period of care requiring coordination of multiple care teams.
Collapse
Affiliation(s)
- Sophie Blais
- Pediatric Department, Poissy Hospital, Poissy, France
| | - Sarah Cohen-Gogo
- Division of Hematology and Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Elodie Gouache
- Department of Pediatric Hematology, Trousseau Hospital (AP-HP), Sorbonne University, Paris, France
| | - Lea Guerrini-Rousseau
- Gustave Roussy Cancer Center, Department of Pediatric and Adolescent Oncology, Paris-Saclay University, Villejuif, France
| | - Benoit Brethon
- Pediatric Hematology Department, Robert Debré Hospital (AP-HP), Paris, France.,RIFHOP, Île-de-France Regional Network of Pediatric Hematology-Oncology, Paris, France
| | - Ilhem Rahal
- Adolescents and Young Adults Hematology Department, Saint-Louis Hospital (AP-HP), Paris, France
| | - Arnaud Petit
- Department of Pediatric Hematology, Trousseau Hospital (AP-HP), Sorbonne University, Paris, France
| | - Graziella Raimondo
- Department of Pediatric Hematology and Oncology, Hôpital d'Enfants Margency, Margency, France.,PALIPED, Regional Pediatric Palliative Care Resource Team of Île-de-France, Paris, France
| | - Beatrice Pellegrino
- Pediatric Department, Poissy Hospital, Poissy, France.,RIFHOP, Île-de-France Regional Network of Pediatric Hematology-Oncology, Paris, France.,PALIPED, Regional Pediatric Palliative Care Resource Team of Île-de-France, Paris, France
| | - Daniel Orbach
- RIFHOP, Île-de-France Regional Network of Pediatric Hematology-Oncology, Paris, France.,SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
| |
Collapse
|
9
|
Abstract
BACKGROUND Children with advanced cancer experience symptoms despite access to quality care. Symptom research has previously relied upon retrospective designs and parent proxy rather than prospective measurement with self-report. OBJECTIVE This study evaluated the feasibility of electronic data collection in children with advanced cancer using self-report of symptom frequency, severity, and distress. METHODS A multisite prospective cohort design was used for this study. Children who were 7 to 18 years of age and English-speaking and had a diagnosis of advanced cancer were included. Symptom frequency, severity, and level of distress were measured every 2 weeks. RESULTS Forty-six children completed 563 of 622 (91%) administered electronic symptom assessments. Pain, fatigue, nausea, and sleeping difficulties were the most reported symptoms across all assessments and during the last 12 weeks of life. Symptoms with the highest composite scores included pain, fatigue, nausea, and sleeping difficulties. During the last 12 weeks of life, pain, fatigue, diarrhea, and sleeping difficulties had the highest composite scores. When the domains of frequency, severity, and distress were compared between groups, children reported significantly higher frequency of pain and eating difficulty during the last 12 weeks of life. CONCLUSIONS Electronic data collection is a feasible way to evaluate the constellation of symptoms. Children with advanced cancer continue to experience physical and psychological symptoms, especially during the last 12 weeks of life despite quality care. IMPLICATIONS FOR PRACTICE Assessment of symptom domains, including frequency, severity, and distress when symptoms are present may allow clinicians to better understand and manage symptoms of most concern to the patient.
Collapse
|
10
|
Tortora S, Raghunathan NJ, Seifert G, Sibinga EMS, Ghelman R. A comprehensive definition for pediatric integrative oncology through an international consensus. Complement Ther Med 2021; 57:102678. [PMID: 33548478 DOI: 10.1016/j.ctim.2021.102678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Suzi Tortora
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, United States.
| | - Nirupa J Raghunathan
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, United States
| | - Georg Seifert
- Department of Pediatrics, Division of Oncology and Hematology, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Germany; Instituto De Tratamento Do Câncer Infantil (ITACI), Departamento De Pediatria, Faculdade De Medicina, Universidade De São Paulo, São Paulo, Brazil
| | | | - Ricardo Ghelman
- Instituto De Tratamento Do Câncer Infantil (ITACI), Departamento De Pediatria, Faculdade De Medicina, Universidade De São Paulo, São Paulo, Brazil; Brazilian Academic Consortium for Integrative Health, Brazil
| |
Collapse
|
11
|
Greenfield K, Holley S, Schoth DE, Harrop E, Howard RF, Bayliss J, Brook L, Jassal SS, Johnson M, Wong I, Liossi C. A mixed-methods systematic review and meta-analysis of barriers and facilitators to paediatric symptom management at end of life. Palliat Med 2020; 34:689-707. [PMID: 32228216 PMCID: PMC7521017 DOI: 10.1177/0269216320907065] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Symptom management for infants, children and young people at end of life is complex and challenging due to the range of conditions and differing care needs of individuals of different ages. A greater understanding of these challenges could inform the development of effective interventions. AIM To investigate the barriers and facilitators experienced by patients, carers and healthcare professionals managing symptoms in infants, children and young people at end of life. DESIGN A mixed-methods systematic review and meta-analysis was undertaken (PROSPERO ID: CRD42019124797). DATA SOURCES The Cochrane Library, PROSPERO, CINAHL, MEDLINE, PsycINFO, Web of Science Core Collection, ProQuest Dissertations & Theses Database, Evidence Search and OpenGrey were electronically searched from the inception of each database for qualitative, quantitative or mixed-methods studies that included data from patients, carers or healthcare professionals referring to barriers or facilitators to paediatric end-of-life symptom management. Studies underwent data extraction, quality appraisal, narrative thematic synthesis and meta-analysis. RESULTS A total of 64 studies were included (32 quantitative, 18 qualitative and 14 mixed-methods) of medium-low quality. Themes were generated encompassing barriers/facilitators experienced by carers (treatment efficacy, treatment side effects, healthcare professionals' attitudes, hospice care, home care, families' symptom management strategies) and healthcare professionals (medicine access, treatment efficacy, healthcare professionals' demographics, treatment side effects, specialist support, healthcare professionals' training, health services delivery, home care). Only one study included patients' views. CONCLUSION There is a need for effective communication between healthcare professionals and families, more training for healthcare professionals, improved symptom management planning including anticipatory prescribing, and urgent attention paid to the patients' perspective.
Collapse
Affiliation(s)
- Katie Greenfield
- School of Psychology, University of Southampton, Southampton, UK
| | - Simone Holley
- School of Psychology, University of Southampton, Southampton, UK
| | - Daniel E Schoth
- School of Psychology, University of Southampton, Southampton, UK
| | - Emily Harrop
- Helen & Douglas House Hospices, Oxford, UK.,John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard F Howard
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Julie Bayliss
- The Louis Dundas Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lynda Brook
- Alder Hey Children's Hospital, Liverpool, UK
| | | | | | - Ian Wong
- UCL School of Pharmacy, London, UK
| | - Christina Liossi
- School of Psychology, University of Southampton, Southampton, UK.,Psychological Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
12
|
The potential of Freestyle Motocross (FMX) therapy as integrative medicine in pediatric oncology: A pre-post study design. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
13
|
Religious and cultural challenges in paediatrics palliative care: A review of literature. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2019. [DOI: 10.1016/j.phoj.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
14
|
Clinical Use of an Order Protocol for Distress in Pediatric Palliative Care. Healthcare (Basel) 2019; 7:healthcare7010003. [PMID: 30609712 PMCID: PMC6473654 DOI: 10.3390/healthcare7010003] [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: 11/27/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 12/05/2022] Open
Abstract
Several children receiving palliative care experience dyspnea and pain. An order protocol for distress (OPD) is available at Sainte-Justine Hospital, aimed at alleviating respiratory distress, pain and anxiety in pediatric palliative care patients. This study evaluates the clinical use of the OPD at Sainte-Justine Hospital, through a retrospective chart review of all patients for whom the OPD was prescribed between September 2009 and September 2012. Effectiveness of the OPD was assessed using chart documentation of the patient’s symptoms, or the modified Borg scale. Safety of the OPD was evaluated by measuring the time between administration of the first medication and the patient’s death, and clinical evolution of the patient as recorded in the chart. One hundred and four (104) patients were included in the study. The OPD was administered at least once to 78 (75%) patients. A total of 350 episodes of administration occurred, mainly for respiratory distress (89%). Relief was provided in 90% of cases. The interval between administration of the first protocol and death was 17 h; the interval was longer in children with cancer compared to other illnesses (p = 0.02). Data from this study support the effectiveness and safety of using an OPD for children receiving palliative care.
Collapse
|
15
|
Hohl CM, Stenekes S, Harlos MS, Shepherd E, McClement S, Chochinov HM. Methotrimeprazine for the management of End-Of-Life Symptoms in Infants and Children. J Palliat Care 2018. [DOI: 10.1177/082585971302900307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This retrospective chart review assessed the efficacy, dose, and safety of methotrimeprazine in palliating end-of-life symptoms in children and infants. Methods: A retrospective chart review was conducted of 18 hospitalized pediatric patients who were treated with methotrimeprazine in their last two weeks of life. Data collected included age, diagnosis, symptoms, methotrimeprazine dose, route, efficacy, and any documented adverse effects. Results: Patients’ ages ranged from 16 days to 17 years. Underlying conditions included malignancies, trauma, and various neurodegenerative and congenital diseases. All patients (n=18) were treated for symptoms of agitation, delirium, or restlessness. Most patients also experienced respiratory secretions/congestion (n=15), pain (n=13), and/ or dyspnea (n=9). Less common symptoms included nausea/emesis (n=5) and spasticity (n=1). Methotrimeprazine dosages ranged from 0.02 mg/kg/dose to 0.5 mg/kg/dose. Routes of administration included intravenous (n=13), oral/gastrostomy tube (n=6), or subcutaneous (n=4). Sedation (n=6) was the only documented adverse effect, although when agitation was present, this was potentially an intended and perceived-to-be-beneficial effect. Conclusion: Methotrimeprazine, an old drug with diverse receptor activity and multiple routes of administration, appears to be an effective tool in treating complicated end-of-life symptoms in children and infants. This study provides a foundation for analysis with prospective and comparative trials, which may further quantify its benefit.
Collapse
Affiliation(s)
- Christopher M. Hohl
- CM Hohl (corresponding author) Department of Pediatrics and Child Health and Department of Family Medicine, University of Manitoba, Adult and Pediatric Palliative Care, Winnipeg Regional Health Authority, Room A8024, St. Boniface General Hospital, 409 Taché Avenue, Winnipeg, Manitoba, Canada R2H 2A6
| | | | - Michael S. Harlos
- MS Harlos: Department of Family Medicine, University of Manitoba, and Adult and Pediatric Palliative Care, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Erin Shepherd
- Faculty of Nursing, University of Manitoba, and Pediatric Palliative Care, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Susan McClement
- Faculty of Nursing, University of Manitoba, and Manitoba Palliative Care Research Unit, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Harvey Max Chochinov
- Department of Psychiatry and Department of Family Medicine, University of Manitoba, and Manitoba Palliative Care Research Unit, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
16
|
von Lützau P, Otto M, Hechler T, Metzing S, Wolfe J, Zernikow B. Children Dying from Cancer: Parents’ Perspectives on Symptoms, Quality of Life, Characteristics of Death, and End-of-Life Decisions. J Palliat Care 2018. [DOI: 10.1177/082585971202800406] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study, we investigated the experience of children who died of cancer, as perceived by their parents. All the pediatric oncology departments in one German federal state were contacted and asked to invite parents who had lost a child to cancer in the period 2005–2006 to participate. Those parents who accepted were interviewed by means of a semi-structured questionnaire. In the participating 16 departments, 158 children died in 2005–2006. Parents of 48 children (38.3 percent) agreed to participate and were interviewed. Nearly all of the children had suffered from at least one distressing symptom. Pain and fatigue occurred most frequently. Symptoms were successfully treated over 65 percent of the time. In all, 64 percent of the children received home care services; 50 percent died at home, and only 10 percent in the ICU. Results suggest that some progress has been made in pediatric palliative care. To further improve end-of-life care for children with cancer, it is also necessary to evaluate parents’ perspectives on structures for pediatric palliative care delivery.
Collapse
Affiliation(s)
- Pia von Lützau
- P von Lützau (corresponding author): Pediatric Palliative Care Centre and German Pediatric Pain Centre, Children's and Adolescents’ Hospital, Datteln and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health — School of Medicine, Dr. Friedrich Steiner Strasse 5, 45711 Datteln, Germany
| | - Michael Otto
- M Otto, T Hechler, B Zernikow: Pediatric Palliative Care Centre and German Pediatric Pain Centre, Children's and Adolescents’ Hospital, Datteln and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health — School of Medicine, Datteln, Germany
| | - Tanja Hechler
- M Otto, T Hechler, B Zernikow: Pediatric Palliative Care Centre and German Pediatric Pain Centre, Children's and Adolescents’ Hospital, Datteln and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health — School of Medicine, Datteln, Germany
| | - Sabine Metzing
- M Otto, T Hechler, B Zernikow: Pediatric Palliative Care Centre and German Pediatric Pain Centre, Children's and Adolescents’ Hospital, Datteln and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health — School of Medicine, Datteln, Germany
| | - Joanne Wolfe
- S Metzing: Witten/Herdecke University, Faculty of Health — School of Nursing Science, Witten, Germany
| | - Boris Zernikow
- J Wolfe: Harvard Medical School, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
17
|
Symptoms and management of children with incurable cancer in mainland China. Eur J Oncol Nurs 2018; 38:42-49. [PMID: 30717935 DOI: 10.1016/j.ejon.2018.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/22/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE This study was designed to report information regarding symptomology of incurable pediatric cancer to promote proactive medicine and support for children and their families in the palliative phase in Mainland China. METHOD A multi-center retrospective cohort study including 205 children who died from incurable cancer between June 2008 and September 2013 were analyzed. RESULTS An incurable diagnosis was confirmed between 0 and 1726 (median, 279) days from initial diagnosis with death occurring between 1 and 239(median, 83) days. The most frequent symptoms were fatigue (93.7%), pain (87.3%), and poor appetite (76.1%). The earliest symptoms were pain and fatigue. Children with leukemia and lymphoma also complained early of nausea/vomiting, and children with solid tumors complained early of disturbed sleep. Later in the palliative phase, altered consciousness and seizures were found in children with central nervous system tumors and solid tumors, while children with leukemia and lymphoma were found to have fever, diarrhea, and bleeding. However, these symptoms only persisted for a short time. DNR discussions were held in 89 cases (43.4%) at a median of 37 (range, 4-178) days before death. A total of 154 patients (75.1%) died at home and 51 patients (24.9%) in the hospital. CONCLUSIONS This study provides new knowledge about symptomology to health care professionals and parents of children in Mainland China. Given our results, an improved alternative care plan should be developed and implemented earlier to facilitate end-of-life planning.
Collapse
|
18
|
Namisango E, Bristowe K, Allsop MJ, Murtagh FEM, Abas M, Higginson IJ, Downing J, Harding R. Symptoms and Concerns Among Children and Young People with Life-Limiting and Life-Threatening Conditions: A Systematic Review Highlighting Meaningful Health Outcomes. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 12:15-55. [DOI: 10.1007/s40271-018-0333-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
19
|
Baenziger PH, Moody K. Palliative Care for Children with Central Nervous System Malignancies. Bioengineering (Basel) 2018; 5:bioengineering5040085. [PMID: 30322131 PMCID: PMC6315897 DOI: 10.3390/bioengineering5040085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023] Open
Abstract
Children with central nervous system (CNS) malignancies often suffer from high symptom burden and risk of death. Pediatric palliative care is a medical specialty, provided by an interdisciplinary team, which focuses on enhancing quality of life and minimizing suffering for children with life-threatening or life-limiting disease, and their families. Primary palliative care skills, which include basic symptom management, facilitation of goals-of-care discussions, and transition to hospice, can and should be developed by all providers of neuro-oncology care. This chapter will review the fundamentals of providing primary pediatric palliative care.
Collapse
Affiliation(s)
- Peter H Baenziger
- Peyton Manning Children's Hospital, Ascension St. Vincent, 2001 West 86th Street, Indianapolis, IN 46260, USA.
| | - Karen Moody
- MD Anderson Cancer Center, University of Texas, 1515 Holcomb Blvd., Unit 87, Houston, TX 77030, USA.
| |
Collapse
|
20
|
Ullrich CK, Dussel V, Orellana L, Kang TI, Rosenberg AR, Feudtner C, Wolfe J. Self-reported fatigue in children with advanced cancer: Results of the PediQUEST study. Cancer 2018; 124:3776-3783. [PMID: 30291811 DOI: 10.1002/cncr.31639] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/10/2018] [Accepted: 05/21/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pediatric cancer-related fatigue is prevalent and significantly impairs health-related quality of life, yet its patterns and correlates are poorly understood. The objectives of this study were to describe fatigue as prospectively reported by children with advanced cancer and to identify the factors associated with fatigue and associated distress. METHODS Children (age ≥2 years) with advanced cancer (N = 104) or their parents at 3 academic hospitals reported symptoms at most weekly over 9 months using the computer-based Pediatric Quality of Life Evaluation of Symptoms Technology (PediQUEST) system. PediQUEST administered a modified version of the Memorial Symptom Assessment Scale (PQ-MSAS) as part of a randomized controlled trial. Clinical information was abstracted from medical records. Primary outcomes were: 1) fatigue prevalence (yes/no response to PQ-MSAS fatigue item) and 2) fatigue distress (composite score of severity, frequency, and bother). Multivariable models were constructed to identify factors independently associated with fatigue prevalence and scores reflecting fatigue distress (ie, burden). RESULTS Of 920 reports, 46% (n = 425) noted fatigue. When reported, fatigue was of high frequency in 41% of respondents (n = 174), severity in 25%of respondents (n = 107), and bother in 34%of respondents (n = 143). Most reports (84%; n = 358) were associated with scores indicating fatigue distress. In multivariable analyses, fatigue was associated with older age, lower hemoglobin, and distress from particular symptoms (anorexia, nausea, sleep disturbance, sadness, and irritability). In contrast, fatigue distress was associated with distress from nausea, cough, and pain. CONCLUSIONS Fatigue is common among children with advanced cancer and is often highly distressing. Interventions focused on uncontrolled symptoms may ease fatigue distress in children with advanced cancer.
Collapse
Affiliation(s)
- Christina K Ullrich
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Veronica Dussel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Center for Research and Implementation in Palliative Care, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Tammy I Kang
- Palliative Care Section, Texas Children's Hospital, Baylor School of Medicine, Houston, Texas
| | - Abby R Rosenberg
- Seattle Children's Hospital Cancer and Blood Disorders Center, Seattle, Washington.,Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Chris Feudtner
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
21
|
Lockwood B, Humphrey L. Supporting Children and Families at a Child's End of Life: Pediatric Palliative Care Pearls of Anticipatory Guidance for Families. Child Adolesc Psychiatr Clin N Am 2018; 27:527-537. [PMID: 30219215 DOI: 10.1016/j.chc.2018.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Mental health professionals can play a key role in helping pediatric patients and their families prepare for and endure the death of a child. Impactful interventions include assisting a family's transition toward acceptance of a child's pending death, using prognostication as a tool in emotional preparedness, and education on expectant symptoms to optimize management and sense of caregiver efficacy.
Collapse
Affiliation(s)
- Bethany Lockwood
- Division of Palliative Medicine, The Ohio State University College of Medicine, McCampbell Hall, 5th Floor, 1581 Dodd Drive, Columbus, OH 43210, USA.
| | - Lisa Humphrey
- Hospice and Palliative Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, A1055, Columbus, OH 43205, USA
| |
Collapse
|
22
|
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.
Collapse
|
23
|
Hinds PS, Wang J, Stern ED, Macpherson CF, Wharton CM, Okorosobo R, Cheng YI, Gross HE, Meany HJ, Jacobs S. Voices of children and adolescents on phase 1 or phase 2 cancer trials: A new trial endpoint? Cancer 2017; 123:3799-3806. [PMID: 28581685 PMCID: PMC5610606 DOI: 10.1002/cncr.30782] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pediatric participants on phase 1 or phase 2 clinical trials for incurable cancer are at risk of experiencing toxicities (adverse events [AEs]) related to trial participation. Multiple AEs are subjective; thus, the real impact of trial treatment cannot be known unless patient subjective reports are solicited. METHODS The authors assessed the feasibility and acceptability of soliciting symptom, function, and quality of life (QOL) reports from participants aged 8 to 18 years who were enrolled on phase 1/2 clinical trials at 4 cancer centers during the first course of chemotherapy. The authors also assessed the reliability and validity of 6 self-report Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric measures and 4 open-ended interview questions at 2 time points (at the time of trial enrollment [T1] and 3 to 4 weeks later [T2]). RESULTS The enrollment rate of 75.9% (20 participants) exceeded the feasibility criterion, and missingness of measures by person, measure, and items at T1 and T2 were lower than the acceptability criteria. New QOL themes were limited to the impact of treatment on families and being away from home, family, and friends for treatment. All but one measure at T1 met the reliability criterion and all measures did so at T2. Validity support was limited however because as theorized, mobility decreased and fatigue increased as AEs increased. CONCLUSIONS Soliciting and documenting symptom, function, and QOL reports from patients aged 8 to 18 years who are enrolled on a phase 1/2 clinical trial is feasible and acceptable to participants, particularly when embedded in trials. Reliable and valid findings can result, making patient self-reported outcomes a possible new trial endpoint. Cancer 2017;123:3799-3806. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Pamela S Hinds
- Department of Nursing Research and Quality Outcomes, Children's National Health System, Washington, DC
- Department of Pediatrics, George Washington University, Washington, DC
| | - Jichuan Wang
- Department of Pediatrics, George Washington University, Washington, DC
- Division of Biostatistics and Study Methodology, Children's National Health System, Washington, DC
| | - Emily Dunn Stern
- Division of Hematology/Oncology, Children's National Health System, Washington, DC
| | | | - Claire M Wharton
- Division of Oncology, Seattle Children's Hospital, Seattle, Washington
| | | | - Yao Iris Cheng
- Division of Biostatistics and Study Methodology, Children's National Health System, Washington, DC
| | - Heather E Gross
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Holly J Meany
- Department of Pediatrics, George Washington University, Washington, DC
- Division of Hematology/Oncology, Children's National Health System, Washington, DC
| | - Shana Jacobs
- Department of Pediatrics, George Washington University, Washington, DC
- Division of Hematology/Oncology, Children's National Health System, Washington, DC
| |
Collapse
|
24
|
End-of-life care in children with hematologic malignancies. Oncotarget 2017; 8:89939-89948. [PMID: 29163800 PMCID: PMC5685721 DOI: 10.18632/oncotarget.21188] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/17/2017] [Indexed: 12/13/2022] Open
Abstract
Introduction Hematologic malignancies (HM) represent the most common neoplasms in childhood. Despite improved overall survival rates, they are still a major contributor to cancer death in children. Aims To determine the proportion of children with HM in pediatric palliative care (PPC) and to identify the clinical characteristics and symptoms in comparison to children with extracranial solid tumors (non HM patients). Patients and Methods This study was conducted as a single-center retrospective cohort study of patients in the care of a large specialized PPC team. Results Fifteen HM and 50 non HM patients were included. Symptoms in which HM patients scored significantly higher than non HM patients were mucositis, difficulty moving, somnolence, fatigue, petechiae and paleness. Blood transfusions were more frequently administered to HM patients, but large external hemorrhage was not observed in any child. A large variety of drugs and appliances were needed by the patients, with morphine being the most frequently prescribed drug. During the study period, a much larger and over the years even increasing number of HM patients (not in the care of the PPC team) died in hospital with an (assumed) curative intent, with two thirds dying in the ICU. Conclusions Children with HM were referred to outpatient PPC with almost the full clinical picture of advanced leukemia. Noteworthy, the number of children with HM dying at home is decreasing in our center, instead a substantial proportion received high-intensity medical hospital care including novel anticancer therapies. These patients thus seem to be at an increased risk of dying in hospital as the right time to transfer them to palliative care is oftentimes missed.
Collapse
|
25
|
Allen JM, Graef DM, Ehrentraut JH, Tynes BL, Crabtree VM. Sleep and Pain in Pediatric Illness: A Conceptual Review. CNS Neurosci Ther 2016; 22:880-893. [PMID: 27421251 PMCID: PMC6492850 DOI: 10.1111/cns.12583] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sleep disruption is a common comorbidity of pediatric pain. Consequences of pain and disrupted sleep, evidence for the pain-sleep relation, and how aspects of illness, treatment, and pharmacological pain management may contribute to or exacerbate these issues are presented. AIMS This conceptual review explored the relation between pain and sleep in children diagnosed with chronic medical or developmental conditions. The goal of this review is to expand upon the literature by examining common themes in sleep disturbances associated with painful conditions across multiple pediatric illnesses. Populations reviewed include youth with intellectual and developmental disabilities (IDD), migraines, cystic fibrosis (CF), sickle cell disease (SCD), cancer, juvenile idiopathic arthritis (JIA), juvenile fibromyalgia (JFM), and functional gastrointestinal disorders (FGIDs). RESULTS Consistent evidence demonstrates that children with medical or developmental conditions are more vulnerable to experiencing pain and subjective sleep complaints than healthy peers. Objective sleep concerns are common but often under-studied. Evidence of the pain-sleep relationship exists, particularly in pediatric SCD, IDD, and JIA, with a dearth of studies directly examining this relation in pediatric cancer, JFM, CF, and FGIDs. Findings suggest that assessing and treating pain and sleep disruption is important when optimizing functional outcomes. CONCLUSION It is essential that research further examine objective sleep, elucidate the pain-sleep relationship, consider physiological and psychosocial mechanisms of this relationship, and investigate nonpharmacological interventions aimed at improving pain and sleep in vulnerable pediatric populations.
Collapse
Affiliation(s)
- Jennifer M Allen
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Danielle M Graef
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Brooklee L Tynes
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Valerie M Crabtree
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
| |
Collapse
|
26
|
Rosenberg AR, Orellana L, Ullrich C, Kang T, Geyer JR, Feudtner C, Dussel V, Wolfe J. Quality of Life in Children With Advanced Cancer: A Report From the PediQUEST Study. J Pain Symptom Manage 2016; 52:243-53. [PMID: 27220948 PMCID: PMC4996729 DOI: 10.1016/j.jpainsymman.2016.04.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/07/2016] [Accepted: 04/27/2016] [Indexed: 12/15/2022]
Abstract
CONTEXT Modifiable factors of health-related quality of life (HRQOL) are poorly described among children with advanced cancer. Symptom distress may be an important factor for intervention. OBJECTIVES We aimed to describe patient-reported HRQOL and its relationship to symptom distress. METHODS Prospective, longitudinal data from the multicenter Pediatric Quality of Life and Symptoms Technology study included primarily patient-reported symptom distress and HRQOL, measured at most weekly with the Memorial Symptoms Assessment Scale and Pediatric Quality of Life inventory, respectively. Associations were evaluated using linear mixed-effects models adjusting for sex, age, cancer type, intervention arm, treatment intensity, and time since disease progression. RESULTS Of 104 enrolled patients, 49% were female, 89% were white, and median age was 12.6 years. Nine hundred and twenty surveys were completed over nine months of follow-up (84% by patients). The median total Pediatric Quality of Life score was 74 (interquartile range 63-87) and was "poor/fair" (e.g., <70) 38% of the time. "Poor/fair" categories were highest in physical (53%) and school (48%) compared to emotional (24%) and social (16%) subscores. Thirteen of 24 symptoms were independently associated with reductions in overall or domain-specific HRQOL. Patients commonly reported distress from two or more symptoms, corresponding to larger HRQOL score reductions. Neither cancer type, time since progression, treatment intensity, sex, nor age was associated with HRQOL scores in multivariable models. Among 25 children completing surveys during the last 12 weeks of life, 11 distressing symptoms were associated with reductions in HRQOL. CONCLUSION Symptom distress is strongly associated with HRQOL. Future research should determine whether alleviating distressing symptoms improves HRQOL in children with advanced cancer.
Collapse
Affiliation(s)
- Abby R Rosenberg
- Seattle Children's Hospital Cancer and Blood Disorders Center, Seattle, Washington, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Christina Ullrich
- Department of Psychosocial Oncology and Palliative Care, Boston, Massachusetts, USA; Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Tammy Kang
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J Russell Geyer
- Seattle Children's Hospital Cancer and Blood Disorders Center, Seattle, Washington, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Chris Feudtner
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Veronica Dussel
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA; Center for Research and Implementation in Palliative Care, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Boston, Massachusetts, USA; Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
27
|
Tomlinson D, Zupanec S, Jones H, O’Sullivan C, Hesser T, Sung L. The lived experience of fatigue in children and adolescents with cancer: a systematic review. Support Care Cancer 2016; 24:3623-31. [DOI: 10.1007/s00520-016-3253-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 04/26/2016] [Indexed: 12/27/2022]
|
28
|
Kuhlen M, Hoell J, Balzer S, Borkhardt A, Janssen G. Symptoms and management of pediatric patients with incurable brain tumors in palliative home care. Eur J Paediatr Neurol 2016; 20:261-269. [PMID: 26753538 DOI: 10.1016/j.ejpn.2015.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/18/2015] [Accepted: 12/06/2015] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Brain tumors have the highest disease-related mortality rate of all pediatric cancers. The goal of this study was to determine whether all children with incurable brain tumors cared for by a pediatric palliative care team in a home setting suffer from the same symptoms towards the end of their lives or whether there are differences between the tumor localizations with implications for palliative care. PATIENTS AND METHODS This study was conducted as a retrospective, single center chart review including all patients treated between January 1st 2000 and December 31st 2013. RESULTS 70 children, adolescents and young adults were included in the analysis. Symptom burden was high with a mean number of symptoms of 7.2 per patient. 74% of the symptoms already existed one week before death. Within the last week of life, impaired consciousness (75.7%) most often occurred. Furthermore, symptoms considerably depended on tumor localization. Patients with supratentorial tumors presented more frequently with seizures (p < 0.05), coma (p < 0.01), nausea and emesis (p < 0.01). Ataxia (p < 0.001) occurred most frequently in infratentorial tumors and speech disturbances (p < 0.05), cranial nerve paralysis (p < 0.001), and tetraparesis (p < 0.001) in brain stem tumors. 84.3% of the patients needed analgesics, only 64.4% WHO class III analgesics. Anticonvulsants were given more often in supratentorial tumors (p < 0.01). CONCLUSIONS Caring for a dying child suffering from a brain tumor needs increased awareness of the neurological deterioration. The symptom pattern strongly depends on the tumor localization and significantly differs between supratentorial, infratentorial and brain stem tumors.
Collapse
Affiliation(s)
- Michaela Kuhlen
- University of Dusseldorf, Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, Moorenstr. 5, 40225 Dusseldorf, Germany.
| | - Jessica Hoell
- University of Dusseldorf, Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, Moorenstr. 5, 40225 Dusseldorf, Germany
| | - Stefan Balzer
- University of Dusseldorf, Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, Moorenstr. 5, 40225 Dusseldorf, Germany
| | - Arndt Borkhardt
- University of Dusseldorf, Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, Moorenstr. 5, 40225 Dusseldorf, Germany
| | - Gisela Janssen
- University of Dusseldorf, Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, Moorenstr. 5, 40225 Dusseldorf, Germany
| |
Collapse
|
29
|
Fischer C, Petriccione M, Donzelli M, Pottenger E. Improving Care in Pediatric Neuro-oncology Patients: An Overview of the Unique Needs of Children With Brain Tumors. J Child Neurol 2016; 31:488-505. [PMID: 26245798 PMCID: PMC5032907 DOI: 10.1177/0883073815597756] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/29/2015] [Indexed: 02/06/2023]
Abstract
Brain tumors represent the most common solid tumors in childhood, accounting for almost 25% of all childhood cancer, second only to leukemia. Pediatric central nervous system tumors encompass a wide variety of diagnoses, from benign to malignant. Any brain tumor can be associated with significant morbidity, even when low grade, and mortality from pediatric central nervous system tumors is disproportionately high compared to other childhood malignancies. Management of children with central nervous system tumors requires knowledge of the unique aspects of care associated with this particular patient population, beyond general oncology care. Pediatric brain tumor patients have unique needs during treatment, as cancer survivors, and at end of life. A multidisciplinary team approach, including advanced practice nurses with a specialty in neuro-oncology, allows for better supportive care. Knowledge of the unique aspects of care for children with brain tumors, and the appropriate interventions required, allows for improved quality of life.
Collapse
Affiliation(s)
- Cheryl Fischer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary Petriccione
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Donzelli
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elaine Pottenger
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
30
|
Thrane SE, Maurer SH, Ren D, Danford CA, Cohen SM. Reiki Therapy for Symptom Management in Children Receiving Palliative Care: A Pilot Study. Am J Hosp Palliat Care 2016; 34:373-379. [PMID: 26858170 DOI: 10.1177/1049909116630973] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pain may be reported in one-half to three-fourths of children with cancer and other terminal conditions and anxiety in about one-third of them. Pharmacologic methods do not always give satisfactory symptom relief. Complementary therapies such as Reiki may help children manage symptoms. OBJECTIVE This pre-post mixed-methods single group pilot study examined feasibility, acceptability, and the outcomes of pain, anxiety, and relaxation using Reiki therapy with children receiving palliative care. METHODS A convenience sample of children ages 7 to 16 and their parents were recruited from a palliative care service. Two 24-minute Reiki sessions were completed at the children's home. Paired t tests or Wilcoxon signed-rank tests were calculated to compare change from pre to post for outcome variables. Significance was set at P < .10. Cohen d effect sizes were calculated. RESULTS The final sample included 8 verbal and 8 nonverbal children, 16 mothers, and 1 nurse. All mean scores for outcome variables decreased from pre- to posttreatment for both sessions. Significant decreases for pain for treatment 1 in nonverbal children ( P = .063) and for respiratory rate for treatment 2 in verbal children ( P = .009). Cohen d effect sizes were medium to large for most outcome measures. DISCUSSION Decreased mean scores for outcome measures indicate that Reiki therapy did decrease pain, anxiety, heart, and respiratory rates, but small sample size deterred statistical significance. This preliminary work suggests that complementary methods of treatment such as Reiki may be beneficial to support traditional methods to manage pain and anxiety in children receiving palliative care.
Collapse
Affiliation(s)
- Susan E Thrane
- 1 College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Scott H Maurer
- 2 Palliative Care, Hematology/Oncology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dianxu Ren
- 3 School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Susan M Cohen
- 3 School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
31
|
|
32
|
Widger K, Friedrichsdorf S, Wolfe J, Liben S, Pole JD, Bouffet E, Greenberg M, Husain A, Siden H, Whitlock JA, Rapoport A. Protocol: Evaluating the impact of a nation-wide train-the-trainer educational initiative to enhance the quality of palliative care for children with cancer. BMC Palliat Care 2016; 15:12. [PMID: 26818836 PMCID: PMC4729125 DOI: 10.1186/s12904-016-0085-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are identified gaps in the care provided to children with cancer based on the self-identified lack of education for health care professionals in pediatric palliative care and in the perceptions of bereaved parents who describe suboptimal care. In order to address these gaps, we will implement and evaluate a national roll-out of Education in Palliative and End-of-Life Care for Pediatrics (EPEC®-Pediatrics), using a 'Train-the-Trainer' model. METHODS/DESIGN In this study we are using a pre- post-test design and an integrated knowledge translation approach to assess the impact of the educational roll-out in four areas: 1) self-assessed knowledge of health professionals; 2) knowledge dissemination outcomes; 3) practice change outcomes; and 4) quality of palliative care. The quality of palliative care will be assessed using data from three sources: a) parent and child surveys about symptoms, quality of life and care provided; b) health record reviews of deceased patients; and c) bereaved parent surveys about end-of-life and bereavement care. After being trained in EPEC®-Pediatrics, 'Master Facilitators' will train 'Regional Teams' affiliated with 16 pediatric oncology programs in Canada. Each team will consist of three to five health professionals representing oncology, palliative care, and the community. Each team member will complete online modules and attend one of two face-to-face conferences, where they will receive training and materials to teach the EPEC®-Pediatrics curriculum to 'End-Users' in their region. Regional Teams will also choose a Tailored Implementation of Practice Standards (TIPS) Kit to guide implementation of a quality improvement project in their region; support will be provided via quarterly meetings with Co-Leads and via a listserv and webinars with other teams. DISCUSSION Through this study we aim to raise the level of pediatric palliative care education amongst health care professionals in Canada. Our study will be a significant step forward in evaluation of the impact of EPEC®-Pediatrics both on dissemination outcomes and on care quality at a national level. Based on the anticipated success of our project we hope to expand the EPEC®-Pediatrics roll-out to health professionals who care for children with non-oncological life-threatening conditions.
Collapse
Affiliation(s)
- Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 130-155 College Street, Toronto, ON, M5T 1P8, Canada. .,Pediatric Advanced Care Team, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Stefan Friedrichsdorf
- Department of Pain Medicine, Palliative Care & Integrative Medicine, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN, 55404, USA.
| | - Joanne Wolfe
- Pediatric Palliative Care Service, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
| | - Stephen Liben
- Pediatric Palliative Care Program, The Montreal Children's Hospital, 2300 Rue Tupper, Montréal, QC, H3H 1P3, Canada.
| | - Jason D Pole
- Pediatric Oncology Group of Ontario, 480 University Avenue, Suite 1014, Toronto, ON, M5G 1 V2, Canada.
| | - Eric Bouffet
- Brain Tumor Program, Division of Hematology/Oncology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Mark Greenberg
- Policy and Clinical Affairs, Pediatric Oncology Group of Ontario, 480 University Avenue, Suite 1014, Toronto, ON, M5G 1 V2, Canada.
| | - Amna Husain
- Department of Family and Community Medicine, University of Toronto, Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, 60 Murray Street, 4th Floor, Toronto, ON, M5T 3 L9, Canada.
| | - Harold Siden
- Canuck Place Children's Hospice, Clinical Professor, Department of Pediatrics, University of British Columbia, 1690 Matthews Avenue, Vancouver, BC, V6J 2 T2, Canada.
| | - James A Whitlock
- Department of Hematology/Oncology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Adam Rapoport
- Pediatric Advanced Care Team, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| |
Collapse
|
33
|
Bidet G, Daoust L, Duval M, Ducruet T, Toledano B, Humbert N, Gauvin F. An Order Protocol for Respiratory Distress/Acute Pain Crisis in Pediatric Palliative Care Patients: Medical and Nursing Staff Perceptions. J Palliat Med 2016; 19:306-13. [PMID: 26788836 DOI: 10.1089/jpm.2015.0100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND An order protocol for distress (OPD), including respiratory distress and acute pain crisis, has been established for pediatric palliative care patients at Sainte-Justine Hospital (SJH). After discussion with the patient/his or her family, the OPD is prescribed by the attending physician whenever judged appropriate. The OPD can then be initiated by the bedside nurse when necessary; the physician is notified after the first dose is administered. OBJECTIVES The study objectives were to evaluate the perceptions and experience of the medical/nursing staff towards the use of the OPD. METHODS A survey was distributed to all physicians/nurses working on wards with pediatric palliative care patients. Answers to the survey were anonymous, done on a voluntary basis, and after consent of the participant. RESULTS Surveys (258/548) were answered corresponding to a response rate of 47%. According to the respondents, the most important motivations in using the OPD were the desire to relieve patient's distress and the speed of relief of distress by the OPD; the most important obstacles were going against the patient's/his or her family's wishes and fear of hastening death. The respondents reported that the OPD was frequently (56%) or always (36%) effective in relieving the patient's distress. The respondents felt sometimes (16%), frequently (34%), or always (41%) comfortable in giving the OPD. They thought the OPD could never (12%), rarely (32%), sometimes (46%), frequently (8%), or always (1%) hasten death. Physicians were less favorable than nurses with the autonomy of bedside nurses to initiate the OPD before notifying the physician (p = 0.04). Overall, 95% of respondents considered that they would use the OPD in the future. CONCLUSIONS Data from this survey shows that respondents are in favor of using the OPD at SJH and find it effective. Further training as well as support for health care professionals are mandatory in such palliative care settings.
Collapse
Affiliation(s)
- Gwenaëlle Bidet
- 1 Palliative Care Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada
| | - Lysanne Daoust
- 1 Palliative Care Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada
| | - Michel Duval
- 2 Hemato-Oncology Service, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada
| | - Thierry Ducruet
- 3 Applied Clinical Research Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada
| | - Baruch Toledano
- 4 Pediatric Critical Care Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada
| | - Nago Humbert
- 1 Palliative Care Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada
| | - France Gauvin
- 1 Palliative Care Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada
| |
Collapse
|
34
|
Montgomery K, Sawin KJ, Hendricks-Ferguson VL. Experiences of Pediatric Oncology Patients and Their Parents at End of Life. J Pediatr Oncol Nurs 2015. [DOI: 10.1177/1043454215589715] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Improvement in pediatric palliative and end-of-life care has been identified as an ongoing research priority. The child and parent experience provides valuable information to guide how health care professionals can improve the transition to end of life and the care provided to children and families during the vulnerable period. The purpose of this systematic review was to describe the experience of pediatric oncology patients and their parents during end of life, and identify gaps to be addressed with interventions. A literature search was completed using multiple databases, including CINAHL, PubMed, and PsycInfo. A total of 43 articles were included in the review. The analysis of the evidence revealed 5 themes: symptom prevalence and symptom management, parent and child perspectives of care, patterns of care, decision making, and parent and child outcomes of care. Guidelines for quality end-of-life care are needed. More research is needed to address methodological gaps that include the pediatric patient and their sibling’s experience.
Collapse
Affiliation(s)
| | - Kathleen J. Sawin
- University of Wisconsin–Milwaukee, Milwaukee, WI, USA
- Children’s Hospital of Wisconsin, Milwaukee, WI, USA
| | | |
Collapse
|
35
|
Kaye EC, Rubenstein J, Levine D, Baker JN, Dabbs D, Friebert SE. Pediatric palliative care in the community. CA Cancer J Clin 2015; 65:316-33. [PMID: 25955682 DOI: 10.3322/caac.21280] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Early integration of pediatric palliative care (PPC) for children with life-threatening conditions and their families enhances the provision of holistic care, addressing psychological, social, spiritual, and physical concerns, without precluding treatment with the goal of cure. PPC involvement ideally extends throughout the illness trajectory to improve continuity of care for patients and families. Although current PPC models focus primarily on the hospital setting, community-based PPC (CBPPC) programs are increasingly integral to the coordination, continuity, and provision of quality care. In this review, the authors examine the purpose, design, and infrastructure of CBPPC in the United States, highlighting eligibility criteria, optimal referral models to enhance early involvement, and fundamental tenets of CBPPC. This article also appraises the role of CBPPC in promoting family-centered care. This model strives to enhance shared decision making, facilitate seamless handoffs of care, maintain desired locations of care, and ease the end of life for children who die at home. The effect of legislation on the advent and evolution of CBPPC also is discussed, as is an assessment of the current status of state-specific CBPPC programs and barriers to implementation of CBPPC. Finally, strategies and resources for designing, implementing, and maintaining quality standards in CBPPC programs are reviewed.
Collapse
Affiliation(s)
- Erica C Kaye
- Dual Fellow in Pediatric Hematology/Oncology and Hospice and Palliative Medicine, Department of Oncology, Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, TN
| | - Jared Rubenstein
- Fellow in Hospice and Palliative Medicine, Haslinger Division of Pediatric Palliative Care, Akron Children's Hospital, Akron, OH
| | - Deena Levine
- Assistant Member, Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, TN
| | - Justin N Baker
- Chief, Division of Quality of Life and Palliative Care, Director, Hematology/Oncology and Hospice and Palliative Medicine Fellowship Programs, St. Jude Children's Research Hospital, Memphis, TN
| | - Devon Dabbs
- Executive Director, Co-Founder, Children's Hospice and Palliative Care Coalition, Salinas, CA
| | - Sarah E Friebert
- Director, Pediatric Palliative Care Program, Haslinger Division of Pediatric Palliative Care, Akron Children's Hospital, Akron, OH
| |
Collapse
|
36
|
Abstract
Hospice is an important provider of end of life care; many children who die of cancer enroll in hospice programs. How frequently such children remain in hospice to die at home, or disenroll from hospice and die in the hospital, has not been described. A child's location of death has important implications for quality of life and parental adaptation. This represents a subanalysis of a retrospective study of 202 consecutive oncology patients who died at a single center between January 1, 2006 and December 31, 2010. Of 95 children who enrolled in hospice, 82 had known location of death. Sixty (73%) died at home or an inpatient hospice unit, 15 (18%) died in the oncology unit, 5 (6%) died in the intensive care unit, and 2 (2%) died in the emergency department. The median length of hospice services was 41 days, twice the national median of 21 days reported in adults. One quarter of children disenrolled from hospice care, ultimately dying in an acute care setting. Further studies are warranted to explore the hospice experience in children, and to address modifiable factors that may impact a family's choice to withdraw from hospice care.
Collapse
|
37
|
Jagt- van Kampen CT, van de Wetering MD, Schouten–van Meeteren AY. The timing, duration, and management of symptoms of children with an incurable brain tumor: a retrospective study of the palliative phase. Neurooncol Pract 2015; 2:70-77. [PMID: 31386060 PMCID: PMC6668256 DOI: 10.1093/nop/npu038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A brain tumor is diagnosed in 25% of pediatric oncology patients and carries a 30% mortality rate. To increase proactive support of children with a progressive brain tumor, we obtained information on timing, duration, and management of symptoms in the palliative trajectory. METHODS A retrospective review of medical charts of patients treated at a children's university hospital, who were dying from a brain tumor between May 2007 and September 2012. RESULTS Thirty-four children were included. After 0-2480 days (median, 168 days) from initial diagnosis, incurable disease was evident, with death occurring after 1-603 days (median, 80 days). Palliative cancer-directed therapy was given to 23 (68%) patients. Early presenting symptoms were altered mobility, speech disorders, and loss of sight or hearing. The symptoms with the shortest duration were somnolence, dysphagia, and dyspnea. The most frequent symptoms were pain (91%), poor mobility (74%), and somnolence (71%). Pain necessitated a short period of intravenous treatment with morphine in 38% of patients, for a median 4 days, and sedation in 15%, for a median 2.5 days. Do-not-resuscitate agreements were discussed with all parents at 0-576 days before death (median, 50 days) and were agreed upon by 33 (97%) parents. Twenty-seven (79%) patients died at home, and one died in a hospice. Six (18%) patients were admitted for intravenous anticonvulsants, pain medication, and sedation until death. CONCLUSIONS This study reports specific information on the timing of occurrence and duration of symptoms. This information will provide support for pediatric oncologists in preparing parents and primary health care professionals and anticipating symptom management and timely end-of-life decision-making in the palliative care phase for children with a brain tumor.
Collapse
|
38
|
Listening to parents: The role of symptom perception in pediatric palliative home care. Palliat Support Care 2015; 14:13-9. [DOI: 10.1017/s1478951515000462] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:This study analyzes symptom perception by parents and healthcare professionals and the quality of symptom management in a pediatric palliative home care setting and identifies which factors contribute to a high quality of palliative and end-of-life care for children.Methods:In this retrospective, cross-sectional study, parents were surveyed at the earliest three months after their child's death. All children were cared for by a specialized home pediatric palliative care team that provides a 24/7 medical on-call service. Questionnaires assessed symptom prevalence and intensity during the child's last month of life as perceived by parents, symptom perception, and treatment by medical staff. The responses were correlated with essential palliative care outcome measures (e.g., satisfaction with the care provided, quality-of-life of affected children and parents, and peacefulness of the dying phase).Results:Thirty-eight parent dyads participated (return rate 84%; 35% oncological disorders). According to parental report, dyspnea (61%) and pain (58%) were the dominant symptoms with an overall high symptom load (83%). Pain, agitation, and seizures could be treated more successfully than other symptoms. Successful symptom perception was achieved in most cases and predicted the quality of symptom treatment (R2, 0.612). Concordant assessment of symptom severity between parents and healthcare professionals (HCPs) improved the satisfaction with the care provided (p = 0.037) as well as the parental quality-of-life (p = 0.041). Even in cases with unsuccessful symptom control, parents were very satisfied with the SHPPC team's care (median 10; numeric rating scale 0–10) and rated the child's death as highly peaceful (median 9).Significance of the results:The quality and the concordance of symptom perception between parents and HCPs essentially influence parental quality-of-life as well as parental satisfaction and constitute a predictive factor for the quality of symptom treatment and palliative care.
Collapse
|
39
|
de Weerd W, van Tol D, Albers M, Sauer P, Verkerk M. Suffering in children: opinions from parents and health-care professionals. Eur J Pediatr 2015; 174:589-95. [PMID: 25326280 DOI: 10.1007/s00431-014-2440-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/07/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Alleviation of suffering is considered to be one of the important goals of medical interventions. Understanding of what constitutes suffering in children admitted to a pediatric intensive care unit (PICU) is lacking. This study aims to assess perceptions by parents, doctors, and nurses of suffering in critically ill children. We interviewed 124 participants (parents, physicians, and PICU nurses) caring for 29 admitted children in a 20-bed level-III PICU and performed a qualitative analysis. We found that most participants made a distinction between physical and existential suffering. Parents considered the child's suffering caused by or associated with visible signs as discomfort. Nurses linked suffering to the child's state of comfort. Physicians linked them to the intensity and impact of treatment and future perspectives of the child. Various aspects of the child's suffering and admission to a PICU caused suffering in parents. CONCLUSION Parents', physicians', and nurses' perceptions of suffering overlap but also show important differences. Differences found seem to be rooted in the relation to and kind of responsibility (parental/professional) for the child. The child's illness, suffering, and hospital admission cause suffering in parents. Health-care professionals in PICUs need to be aware of these phenomena.
Collapse
Affiliation(s)
- Willemien de Weerd
- Department of Pediatrics, Division of Intensive Care, Beatrix Children's Hospital, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands,
| | | | | | | | | |
Collapse
|
40
|
Widger K, Bouffet E, Friedrichsdorf S, Greenberg M, Husain A, Liben S, Pole JD, Siden H, Whitlock J, Wolfe J, Rapoport A. Enhancing the quality of palliative care for children with cancer: A nation-wide train-the-trainer educational initiative. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.3.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
41
|
Humphrey L, Kang TI. Palliative care in pediatric patients with hematologic malignancies. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2015; 2015:490-495. [PMID: 26637763 DOI: 10.1182/asheducation-2015.1.490] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Children with advanced cancer, including those with hematologic malignancies, can benefit from interdisciplinary palliative care services. Palliative care includes management of distressing symptoms, attention to psychosocial and spiritual needs, and assistance with navigating complex medical decisions with the ultimate goal of maximizing the quality-of-life of the child and family. Palliative care is distinct from hospice care and can assist with the care of patients throughout the cancer continuum, irrespective of prognosis. While key healthcare organizations, including the Institute of Medicine, the American Academy of Pediatrics and the American Society of Clinical Oncology among many others endorse palliative care for children with advanced illness, barriers to integration of palliative care into cancer care still exist. Providing assistance with advance care planning, guiding patients and families through prognostic uncertainty, and managing transitions of care are also included in goals of palliative care involvement. For patients with advanced malignancy, legislation, included in the Patient Protection and Affordable Health Care Act allows patients and families more options as they make the difficult transition from disease directed therapy to care focused on comfort and quality-of-life.
Collapse
Affiliation(s)
| | - Tammy I Kang
- The Children's Hospital of Philadelphia, Philadelphia, PA
| |
Collapse
|
42
|
Cataudella D, Morley TE, Nesin A, Fernandez CV, Johnston DL, Sung L, Zelcer S. Development of a quality of life instrument for children with advanced cancer: the pediatric advanced care quality of life scale (PAC-QoL). Pediatr Blood Cancer 2014; 61:1840-5. [PMID: 24947134 DOI: 10.1002/pbc.25115] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 05/01/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is currently no published, validated measures available that comprehensively capture quality of life (QoL) symptoms for children with poor-prognosis malignancies. The pediatric advanced care-quality of life scale (PAC-QoL) has been developed to address this gap. The current paper describes the first two phases in the development of this measure. PROCEDURES The first two phases included: (1) construct and item generation, and (2) preliminary content validation. Domains of QoL relevant to this population were identified from the literature and items generated to capture each; items were then adapted to create versions sensitive to age/developmental differences. Two types of experts reviewed the draft PAC-QoL and rated items for relevance, understandability, and sensitivity of wording: bereaved parents (n = 8) and health care professionals (HCP; n = 7). Content validity was calculated using the index of content validity (CVI [Lynn. Nurs Res 1986;35:382-385]). RESULTS One hundred and forty-one candidate items congruent with the domains identified as relevant to children with advanced malignancies were generated, and four report versions with a 5-choice response scale created. Parent mean scores for importance, understandability, and sensitivity of wording ranged from 4.29 (SD = 0.52) to 4.66 (SD = 0.50). The CVI ranged from 95% to 100%. These steps resulted in reductions of the PAC-QoL to 57-65 items, as well as a modification of the response scale to a 4-choice option with new anchors. CONCLUSIONS The next phase of this study will be to conduct cognitive probing with the intended population to further modify and reduce candidate items prior to psychometric evaluation.
Collapse
Affiliation(s)
- Danielle Cataudella
- Department of Psychology, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
43
|
Morley TE, Cataudella D, Fernandez CV, Sung L, Johnston DL, Nesin A, Zelcer S. Development of the Pediatric Advanced Care Quality of Life Scale (PAC-QoL): evaluating comprehension of items and response options. Pediatr Blood Cancer 2014; 61:1835-9. [PMID: 24947009 DOI: 10.1002/pbc.25111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 04/15/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Validated tools that measure quality of life (QOL) for children with poor prognosis malignancies are not available. We are developing a novel instrument, The Pediatric Advanced Care-Quality of Life Scale (PAC-QoL), in order to address this gap. Instrument development requires a phase of item reduction and assessment of item comprehension in the target population. This manuscript provides a report on this phase in the development of the PAC-QoL. PROCEDURE Children with poor prognosis cancer and/or their parents were invited to participate in cognitive probing interviews. Participants' understanding of each item was rated from 0 (did not understand) to 4 (completely understood). To evaluate the response scale, an overall percentage of respondents' ability to accurately distinguish between the four response options was calculated. RESULTS Four age- and reporter-specific versions of the PAC-QoL were tested with 74 participants. Mean (±SD) comprehension scores across versions ranged from 3.40 ± .0.30 (child self-report) to 3.69 ± 0.23 (parent of toddler report). The number of items deleted or modified to improve understandability ranged from 46% of all items on the parent-of-child report to 56% for the child and adolescent self-reports. Respondent's abilities to accurately distinguish between response-scale options ranged from 84% (child-report) to 98% (parent-toddler report). CONCLUSIONS We demonstrate a high degree item understandability and response-scale separation in the current version of the PAC-QoL. The scale is ready for psychometric evaluation in its target population.
Collapse
Affiliation(s)
- Tara Elise Morley
- Department of Psychology, University of Western Ontario, London, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
High-quality palliative care is the standard for children with life-threatening illness, especially when a cure is not possible. This review outlines a model for clinical practice that integrates clinical, psychosocial, and ethical concerns at the end of life (EOL) into a standard operating procedure specifically focused on inpatient deaths. Palliative care for children at EOL in the hospital setting should encompass the personal, cultural, and spiritual needs of the child and family members and aim to minimize suffering and increase support for all who are involved, including hospital staff.
Collapse
Affiliation(s)
- Liza-Marie Johnson
- St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 260, Memphis, TN 38105, USA.
| | - Jennifer M Snaman
- St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 260, Memphis, TN 38105, USA
| | - Margaret C Cupit
- St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 260, Memphis, TN 38105, USA
| | - Justin N Baker
- St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 260, Memphis, TN 38105, USA
| |
Collapse
|
45
|
Eskola K, Bergstraesser E, Zimmermann K, Cignacco E. Paediatric end-of-life care in the home care setting (PELICAN HOME)--a mixed methods study protocol. J Adv Nurs 2014; 71:204-13. [PMID: 24909918 DOI: 10.1111/jan.12463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2014] [Indexed: 11/29/2022]
Abstract
AIMS (a) To explore parental experiences and needs during their child's end-of-life care at home; (b) to explore patient's characteristics and current provision of paediatric end-of-life care in the home care setting in Switzerland; and (c) to determine influencing system factors impacting end-of-life care at home. BACKGROUND Parental experiences/needs and paediatric end-of-life care services in the home care setting are influenced by national healthcare policy, determinants of the family and the individual patient. In Switzerland, there is a lack of information about the provision of paediatric end-of-life care at home and related parent's experiences/needs. DESIGN Sub-study of the nationwide multicenter study 'Paediatric End-of-Life CAre Needs in Switzerland' using a concurrent qualitative embedded mixed methods design. METHODS Data will be collected from January-May 2014 through community care organizations and children's hospitals. The study includes approximately 40-50 families whose child (0-18 years) died in the years 2011-2012 due to a cardiological, neurological or oncological condition and spent at least 21 days at home during the last 4 weeks of life. Qualitative data will be collected through semi-structured interviews with parents and analysed by 'thematic analysis'. Quantitative data about patient's characteristics will be obtained from patient's medical charts and parental experiences/needs through the parental questionnaire. Appropriate descriptive and inference statistical methods will be used for data analysis. DISCUSSION This study will provide comprehensive basic information about parental needs and patient characteristics for the provision of paediatric end-of-life care and may promote the development of family-centred paediatric end-of-life care services at home. STUDY REGISTRATION The PELICAN-study is registered in the database of Clinical Trial gov. Study ID-number: NCT 01983852.
Collapse
Affiliation(s)
- Katri Eskola
- Institute of Nursing Science, University of Basel, Switzerland
| | | | | | | |
Collapse
|
46
|
Shaw KL, Brook L, Cuddeford L, Fitzmaurice N, Thomas C, Thompson A, Wallis M. Prognostic indicators for children and young people at the end of life: A Delphi study. Palliat Med 2014; 28:501-512. [PMID: 24577064 DOI: 10.1177/0269216314521852] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recognizing transitions in end of life care for children is difficult and hinders communication and care planning. AIM To identify the signs and symptoms that are most useful in signalling which children may have end of life care needs. METHODS A Delphi study was undertaken with palliative care professionals who rated the extent to which 75 symptoms alerted them that a child/young person may have moved into his or her last (a) weeks/days, (b) 6-12 months of life using a 7-point response scale. Level of support for items was indicated by the median, and consensus was shown by the mean absolute deviation from the median. The impact of the Delphi on final agreement and consensus was also assessed. RESULTS Second-round questionnaires were completed by 49 (89%) individuals. It was easier to identify prognostic items in the last weeks/days than earlier in the end of life trajectory. Items most indicative included failure of physiological systems, deteriorating level of consciousness, loss of autonomic control (e.g. breathing and peripheral circulation), together with a feeling of the professional that life is ending and an agreement that resuscitation would be futile. Items most indicative of last 6/12 months suggest a progressive decline in disease trajectory, increased chest infections or other complications from which the child has difficulty in making a full recovery and which may require high dependency or critical care. CONCLUSION This study provides important insight into which signs and symptoms are considered most valuable in identifying children approaching the end of the life.
Collapse
Affiliation(s)
- Karen L Shaw
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Lynda Brook
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Lisa Cuddeford
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nicki Fitzmaurice
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Claire Thomas
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Angela Thompson
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Maybelle Wallis
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
47
|
Referral practices of pediatric oncologists to specialized palliative care. Support Care Cancer 2014; 22:2315-22. [PMID: 24671435 DOI: 10.1007/s00520-014-2203-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The aims of this study are to describe the attitudes and referral practices of pediatric oncologists (POs) to specialized palliative care (SPC), and to compare them with those of adult oncologists (AOs). METHODS Canadian members of the American Society of Pediatric Hematology/Oncology (ASPHO), Canadian Association of Medical Oncologists (CAMO), Canadian Association of Radiation Oncologists (CARO), and the Canadian Society of Surgical Oncology (CSSO) participated in an anonymous survey assessing SPC referral practices. RESULTS The response rate was 70 % (646/921), 52 % (43/82) for ASPHO members; 5 CARO members self-identified as POs, for a total of 48 POs and 595 AOs. Ninety-six percent of POs had access to inpatient SPC consultation services (vs. 48 % AOs), 31 % to a PCU (vs. 82 % AOs), and 27 % to an outpatient SPC clinic (vs. 73 % AOs). POs more often stated their SPC services accepted patients on chemotherapy than AOs (64 vs. 37 %, p = 0.0004). POs were less likely to refer only after chemotherapy had been stopped (13 vs. 29 % for AOs) and more likely to state that ideally referral should occur at the diagnosis of cancer/incurable cancer (73 vs. 43 %). POs were more likely to agree they would refer earlier if palliative care were renamed "supportive care" (58 vs. 33 %, p < 0.0001), that palliative care adds too many providers (17 vs. 7 %, p = 0.002), and that palliative care was perceived negatively by their patients (60 vs. 43 %, p = 0.02). CONCLUSIONS Although POs acknowledge the importance of early referral to SPC for children with cancer, there remain resource and attitudinal barriers to overcome in this regard.
Collapse
|
48
|
Beringer AJ, Heckford EJ. Was there a plan? End-of-life care for children with life-limiting conditions: a review of multi-service healthcare records. Child Care Health Dev 2014. [PMID: 23198741 DOI: 10.1111/cch.12020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Planning for care at the end of life (EoL) is an essential component of support and care for families of children with life-limiting conditions. The purpose of this review was to compare documented EoL planning with published children's palliative care standards, across a range of children's healthcare services and to assess the impact on practice of written guidelines to support EoL care planning. METHOD A manual retrospective review of healthcare records using a purpose-built form. Inclusion criteria were the records of children with a diagnosed life-limiting or life-threatening condition, who had died before the age of 18 years, between October 2008 and March 2010, within a defined geographical area served by one or more of the participating services. The sample was 114 sets of notes relating to a cohort of 48 children: 24 girls and 24 boys, the majority of whose deaths were cancer related. RESULTS Examples of good practice were found in the records of individual services. Services had each developed their own systems and documents to support EoL care planning rather than using a unified documentation system. Where documented practice fell short, this was related to a lack of evidence that choice in location of death had been offered, delays in sharing of information between services, and information being buried in the narrative of the notes, making it difficult to find. CONCLUSIONS Current documented EoL planning varies between services. Those who are infrequently involved in the provision of EoL care may benefit from support by those for whom this is part of their daily working life. These professionals can help prepare staff to engage families in these difficult but important conversations - and encourage them to document them in a way that can be easily and readily accessed and shared.
Collapse
Affiliation(s)
- A J Beringer
- Faculty of Health & Life Sciences, University of the West of England, Glenside Campus, Bristol, UK
| | | |
Collapse
|
49
|
Hileli I, Weyl Ben Arush M, Hakim F, Postovsky S. Association between religious and socio-economic background of parents of children with solid tumors and DNR orders. Pediatr Blood Cancer 2014; 61:265-8. [PMID: 23940107 DOI: 10.1002/pbc.24712] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 07/08/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND The influence of socio-economic and religious background on decisions made by parents of children with incurable cancer regarding DNR orders is not fully understood. PROCEDURE A retrospective analysis of medical charts of patients who died between January 2000 and January 2011 was performed. The following data were sought: written evidence of DNR discussion with parents, religious background, educational level, monthly income. RESULTS There was evidence of a discussion on DNR in 73/90 charts. DNR consent was obtained in 14/17 (82.4%) cases where at least one parent had >15 years of education versus in only 24/45 (53.3%) cases where both parents had ≤15 years education as determined by univariate analysis (P = 0.03). DNR consent was also more likely to be obtained among parents of children with income >10,000 NIS (24/30, 80.0% vs. 20/38, 52.6%, P = 0.013). Parents of Jewish (22/30, 73.3%), Islamic (16/26, 61.5%), and Christian (8/9, 88.9%) background were equally likely to provide DNR consent. However, Druze families were less likely to do so (2/8, 25.0%, P = 0.036). CONCLUSIONS The process of decision-making to a DNR request was associated with parents' educational level and monthly family income, and not by religious background, with the exception of Druze families.
Collapse
Affiliation(s)
- Inbal Hileli
- Department of Pediatric Oncology/Hematology, Meyer Children's Hospital, Rambam Health Care Campus, and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | | | | |
Collapse
|
50
|
|