Pediatric Palliative Care for Children with Cancer in a Children's Tertiary Hospital in China: Six-Year Experience of a Pediatric Palliative Care Service

Purpose In the past decade studies have documented substantial suffering among children dying of cancer, prompting national attention on the quality of end-of-life care and the development of a palliative care service in our institutions. We sought to determine whether national and local efforts have led to changes in patterns of care, advanced care planning, and symptom control among children with cancer at the end of life. Methods Retrospective cohort study from a US tertiary level pediatric institution. Parent survey and chart review data from 119 children who died between 1997 and 2004 (follow-up cohort) were compared with 102 children who died between 1990 and 1997 (baseline cohort). Results In the follow-up cohort, hospice discussions occurred more often (76% v 54%; adjusted risk difference [RD], 22%; P < .001) and earlier (adjusted geometric mean 52 days v 28 days before death; P = .002) compared with the baseline cohort. Do-not-resuscitate orders were also documented earlier (18 v 12 days; P = .031). Deaths in the intensive care unit or other hospitals decreased significantly (RD, 16%; P = .024). Parents reported less child suffering from pain (RD, 19%; P = .018) and dyspnea (RD, 21%; P = .020). A larger proportion of parents felt more prepared during the child's last month of life (RD, 29%; P < .001) and at the time of death (RD, 24%; P = .002). Conclusion Children dying of cancer are currently receiving care that is more consistent with optimal palliative care and according to parents, are experiencing less suffering. With ongoing growth of the field of hospice and palliative medicine, further advancements are likely.

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Development of a State-Wide Pediatric Palliative Care Service in Australia: Referral and Outcomes over Two Years

Journal of Palliative Medicine ◽

10.1089/jpm.2013.0400 ◽

2014 ◽

Vol 17 (3) ◽

pp. 288-295 ◽

Cited By ~ 6

Author(s):

Anthony Herbert ◽

Natalie Bradford ◽

Leigh Donovan ◽

Lee-Anne Pedersen ◽

Helen Irving

Keyword(s):

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Pediatric Palliative Care

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The First Step to Initiate Pediatric Palliative Care: Identify Patient Needs and Cooperation of Medical Staff

Healthcare ◽

10.3390/healthcare10010127 ◽

2022 ◽

Vol 10 (1) ◽

pp. 127

Author(s):

Su Hyun Bae ◽

Yeo Hyang Kim

Keyword(s):

Palliative Care ◽

Medical Staff ◽

Care Service ◽

Care Center ◽

Palliative Care Service ◽

Disease Diagnosis ◽

Pediatric Palliative Care ◽

Number Of Patients ◽

Palliative Care Services ◽

Limiting Condition

Few Korean hospitals had experience in pediatric palliative care. Since the beginning of the national palliative care project, interest in pediatric palliative care has gradually increased, but the establishment of professional palliative care is still inadequate due to a lack of indicators. This study aimed to find considerations in the process of initiating palliative care services. The general and clinical characteristics of 181 patients aged less than 24 years who were registered at the pediatric palliative care center from January 2019 to August 2021 were evaluated. Life-limiting condition group 1 had the largest number of patients. The primary need for palliative care was psychological and emotional support, followed by information sharing and help in communication with the medical staff in decision-making processes. Seventy-two patients were technologically dependent, with one to four technical supports for each patient. The registration of patients with cancer increased with time, and the time from disease diagnosis to consultation for pediatric palliative care service was significantly reduced. In conclusion, before starting pediatric palliative care, it is necessary to understand the needs of patients and their families and to cooperate with medical staff.

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Developing a Pediatric Palliative Care Service in a Large Urban Hospital: Challenges, Lessons, and Successes

Journal of Palliative Medicine ◽

10.1089/jpm.2012.0187 ◽

2013 ◽

Vol 16 (4) ◽

pp. 342-348 ◽

Cited By ~ 8

Author(s):

Emily S. Edlynn ◽

Sabrina Derrington ◽

Helene Morgan ◽

Jennifer Murray ◽

Beatriz Ornelas ◽

...

Keyword(s):

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Pediatric Palliative Care ◽

Urban Hospital

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Interventions to Increase Referrals to a New Pediatric Palliative Care Service: A QI project

Biomedical Journal of Scientific & Technical Research ◽

10.26717/bjstr.2018.07.001555 ◽

2018 ◽

Vol 7 (5) ◽

Author(s):

Ratna Basak

Keyword(s):

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Pediatric Palliative Care

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Dyspnea—Can we do more? A view from a tertiary hospital palliative care service

Progress in Palliative Care ◽

10.1080/09699260.2016.1186342 ◽

2016 ◽

Vol 24 (6) ◽

pp. 305-309

Author(s):

Shirlyn Hui Shan Neo ◽

Grace Su Yin Pang ◽

Patricia Soek Hui Neo

Keyword(s):

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Tertiary Hospital

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A Week in the Life: Pediatric Palliative Care through the Eyes of a Medical Student

Children ◽

10.3390/children8110971 ◽

2021 ◽

Vol 8 (11) ◽

pp. 971

Author(s):

Eileen Williams ◽

Jill Ann Jarrell ◽

Jared Rubenstein

Keyword(s):

Palliative Care ◽

Medical Student ◽

Care Service ◽

Personal Narratives ◽

Palliative Care Service ◽

Reflective Writing ◽

Pediatric Palliative Care ◽

Difficult Situations ◽

Common Misconceptions

To complete the curriculum, learners rotating through a pediatric palliative care service are asked to submit a piece of reflective writing. Here, we share an edited version of the narrative one student submitted, accompanied by a brief consideration of the numerous benefits of reflective writing for medical trainees (including improved communication and professionalism skills, as well as increased levels of empathy and comfort when facing complex or difficult situations). Additionally, we describe how brief personal narratives may serve to reduce common misconceptions and confusion by educating patients, families, and clinicians about the reality and the role of pediatric palliative care.

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Palliative Prognostic Index application at an inpatient palliative care service from a Brazilian tertiary Hospital: A prospective observational study.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.11537 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 11537-11537

Author(s):

Tiago Pugliese Branco ◽

Alze Pereira dos Santos Tavares ◽

Mariana Sarkis Braz ◽

Mariana Ribeiro Monteiro ◽

Ana Beatriz Kinupe Abrahao ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Care Service ◽

Prognostic Index ◽

Palliative Care Service ◽

Tertiary Hospital ◽

Care Physician ◽

Survival Prediction ◽

Advanced Cancer Patients

11537 Background: Palliative Care Index (PPI) has been proposed to improve the accuracy of survival prediction for advanced cancer patients. The aim of this study is to investigate the feasibility and real-world prognosis survival of oncology inpatients from a Brazilian tertiary hospital using PPI. Methods: Hospitalized advanced cancer patients who have been referred to the Palliative Care Team were enrolled from May 2011 to December 2018. The PPI was collected within 24 hours of the referral by the palliative care physician. Primary endpoint was median overall survival (OS), estimated with the use of the Kaplan–Meier method, in three groups: PPI < 4.0; 4.0 ≤ PPI > 6.0 and PPI ≥ 6.0. Secondary endpoints were OS rate at 3-week for patients with PPI ≥ 6.0, and the most accurate PPI value to predict 6 and 3-week survival, calculated by ROC curve. Results: Total of 1.381 patients were included in this cohort with a median age of 68-year-old, and 51.3% of females. The most frequent primary cancer sites were lung/chest (17,2%), colorectal (14,3%), breast (11,2%), and biliopancreatic (10,9%). Among 454 patients with PPI < 4.0, median OS was 44 days (95% CI: 35,5-52,4); 20 days (95% CI: 15,4-24,5) for 260 patients with 4.0≤ PPI < 6.0 and 8 days (95% CI: 7-8,9) between 655 patients with PPI ≥ 6. Differences in OS among the groups adjusted for primary site, age and gender were significant (p < 0,001). OS rate at 3 weeks for PPI≥ 6.0 was 28.1% (OR 5,39 p < 0.001). PPI value of < 5,5 best predicted 6-week OS (79% sensibility, 55% specificity, AUC 0,714) and the PPI value of ≥ 5,5 predicted 3-week OS (67% sensibility, 73% specificity, AUC 0,753). Conclusions: PPI is feasible and suitable for routine clinical practice to predict survival among Brazilian patients with advanced cancer. In our study, PPI 5.5 seems to be the most accurate value to predict survival within 3 weeks.

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