Pediatric Palliative Care Pharmacy Pearls—A Focus on Pain and Sedation

Determining the optimal dosing regimen for pediatric patients is a challenge due to the lack of dosing guidelines and studies. In addition, many developmental pharmacology changes that occur throughout childhood that have profound impacts on the absorption, distribution, metabolism, and elimination of medications are commonly used in palliative care. Adding to that complexity, certain medications have different effects in the pediatric patient compared to the adult patient. Being aware of the pharmacokinetic changes, impact on neurodevelopment and unique medication factors that are present in pediatric patients helps clinicians treat the pediatric palliative care patient in the best and safest way possible.

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My Pediatric Palliative Care Patient with a DNR Is Going to the Operating Room—Questions to Ask the Anesthesiologist (TH337)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2019.12.075 ◽

2020 ◽

Vol 59 (2) ◽

pp. 426

Author(s):

Sydney Brown ◽

Chris Feudtner

Keyword(s):

Palliative Care ◽

Operating Room ◽

Care Patient ◽

Pediatric Palliative Care ◽

Palliative Care Patient

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Opioid-Induced Respiratory Depression in Pediatric Palliative Care Patients with Severe Neurological Impairment—A Scoping Literature Review and Case Reports

Children ◽

10.3390/children7120312 ◽

2020 ◽

Vol 7 (12) ◽

pp. 312

Author(s):

Maximilian David Mauritz ◽

Carola Hasan ◽

Larissa Alice Dreier ◽

Pia Schmidt ◽

Boris Zernikow

Keyword(s):

Risk Factors ◽

Palliative Care ◽

Young Adults ◽

Scoping Review ◽

Pediatric Patients ◽

Case Reports ◽

Neurological Impairment ◽

Opioid Therapy ◽

Pediatric Palliative Care ◽

Severe Neurological Impairment

Pediatric Palliative Care (PPC) addresses children, adolescents, and young adults with a broad spectrum of underlying diseases. A substantial proportion of these patients have irreversible conditions accompanied by Severe Neurological Impairment (SNI). For the treatment of pain and dyspnea, strong opioids are widely used in PPC. Nonetheless, there is considerable uncertainty regarding the opioid-related side effects in pediatric patients with SNI, particularly concerning Opioid-Induced Respiratory Depression (OIRD). Research on pain and OIRD in pediatric patients with SNI is limited. Using scoping review methodology, we performed a systematic literature search for OIRD in pediatric patients with SNI. Out of n = 521 identified articles, n = 6 studies were included in the review. Most studies examined the effects of short-term intravenous opioid therapy. The incidence of OIRD varied between 0.13% and 4.6%; besides SNI, comorbidities, and polypharmacy were the most relevant risk factors. Additionally, three clinical cases of OIRD in PPC patients receiving oral or transdermal opioids are presented and discussed. The case reports indicate that the risk factors identified in the scoping review also apply to adolescents and young adults with SNI receiving low-dose oral or transdermal opioid therapy. However, the risk of OIRD should never be a barrier to adequate symptom relief. We recommend careful consideration and systematic observation of opioid therapy in this population of patients.

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Paediatric palliative screening scale as a useful tool for clinicians’ assessment of palliative care needs of pediatric patients: a retrospective cohort study

BMC Palliative Care ◽

10.1186/s12904-021-00765-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

In Gyu Song ◽

Seung Yeon Kwon ◽

Yoon Jung Chang ◽

Min Sun Kim ◽

Sung Hoon Jeong ◽

...

Keyword(s):

Palliative Care ◽

Retrospective Cohort ◽

Pediatric Patients ◽

Palliative Care Team ◽

Pediatric Palliative Care ◽

Care Needs ◽

Palliative Care Teams ◽

Primary Care Clinicians ◽

Palliative Care Needs ◽

Screening Scale

Abstract Background Although the importance of palliative care in pediatric patients has been emphasized, many health care providers have difficulty determining when patients should be referred to the palliative care team. The Paediatric Palliative Screening Scale (PaPaS) was developed as a tool for screening pediatric patients for palliative care needs. The study aimed to evaluate the PaPaS as a reliable tool for primary care clinicians unfamiliar with palliative care. Methods This was a retrospective cohort study of patients referred to the pediatric palliative care teams in two tertiary hospitals in the Republic of Korea between July 2018 and October 2019. Results The primary clinical and pediatric palliative care teams assessed the PaPaS scores of 109 patients, and both teams reported a good agreement for the sum of the PaPaS score. Furthermore, the PaPaS scores correlated with those obtained using the Lansky performance scale. Although the mean PaPaS score was higher in the pediatric palliative care team, the scores were higher than the cut-off score for referral in both groups. Conclusion The PaPaS can be a useful tool for primary care clinicians to assess the palliative care needs of patients and their families.

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Republished: Which questions of two commonly used multidimensional palliative care patient reported outcome measures are most useful? Results from the European and African PRISMA survey

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2011-000061rep ◽

2012 ◽

Vol 88 (1042) ◽

pp. 451-457 ◽

Cited By ~ 12

Author(s):

Irene J Higginson ◽

Steffen T Simon ◽

Hamid Benalia ◽

Julia Downing ◽

Barbara A Daveson ◽

...

Keyword(s):

Palliative Care ◽

Outcome Measures ◽

Patient Reported Outcome Measures ◽

Care Patient ◽

Patient Reported Outcome ◽

Palliative Care Patient ◽

Patient Reported

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Hypercalcemia of malignancy in the palliative care patient: A treatment strategy

Journal of Pain and Symptom Management ◽

10.1016/0885-3924(94)00127-7 ◽

1995 ◽

Vol 10 (3) ◽

pp. 224-232 ◽

Cited By ~ 19

Author(s):

Christopher S. Kovacs ◽

Susan M. MacDonald ◽

Constance L. Chik ◽

Eduardo Bruera

Keyword(s):

Palliative Care ◽

Treatment Strategy ◽

Care Patient ◽

Palliative Care Patient ◽

Hypercalcemia Of Malignancy

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Inadequate Pain Control in a Palliative Care Patient Due to Lack of Communication Across Continuum of Care (427-A)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2009.02.118 ◽

2009 ◽

Vol 37 (3) ◽

pp. 512

Keyword(s):

Palliative Care ◽

Pain Control ◽

Continuum Of Care ◽

Care Patient ◽

Palliative Care Patient

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Regarding a definition of the palliative care patient

Palliative Medicine ◽

10.1177/0269216313493220 ◽

2013 ◽

Vol 27 (10) ◽

pp. 952-953 ◽

Cited By ~ 1

Author(s):

Hunter Groninger

Keyword(s):

Palliative Care ◽

Care Patient ◽

Palliative Care Patient ◽

Definition Of

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Family Stress

10.1093/med/9780190059996.003.0025 ◽

2021 ◽

pp. 431-441

Author(s):

Denis Snow ◽

Mary Ellen Lasala

Keyword(s):

Palliative Care ◽

Family Stress ◽

Care Patient ◽

Family Preservation ◽

Palliative Care Patient ◽

Legal Requirements ◽

Serious Illness ◽

Faith Based ◽

Culturally Appropriate Care ◽

Advance Planning

Serious illness creates a need for financial and legal support for individuals and their families. Nonmedical issues are often as pressing on them as their medical concerns. Clinicians must have a basic understanding of meeting those needs of advance planning, income and family maintenance, access to insurance, and family preservation within the context of culturally appropriate care. Knowledge of community and faith-based resources to meet the nonmedical needs of the palliative care patient is an essential aspect of care. Since these are often unknown to patients and their families, the clinician must know how to guide patients through the morass of cultural and legal requirements for this purpose.

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