Defining the Boundaries of Palliative Care in Pediatric Oncology

Cuviello, Andrea; Raisanen, Jessica C.; Donohue, Pamela; Wiener, Lori; Boss, Renee D.

doi:10.1016/j.jpainsymman.2019.11.022

Cited by 30 publications

(37 citation statements)

References 35 publications

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“…The very same definition of “Palliative Medicine” is often misinterpreted as “end-of-life care” by parents of children eligible to PnPC and even by healthcare providers ( 19 ). This misinterpretation denies patients the opportunity of appropriate treatment.…”

Section: Socio-cultural Settingmentioning

confidence: 99%

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Barriers to Perinatal Palliative Care Consultation

Benini¹,

Congedi²,

Rusalen³

et al. 2020

Front. Pediatr.

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Section: Socio-cultural Settingmentioning

confidence: 99%

“…Information on PnPC and the possibility to “cure” life-limiting or life-threatening diseases is scant, at best, and this lack of information limits the decision-making process by parents of children eligible to PnPC ( 19 ).…”

Section: Socio-cultural Settingmentioning

confidence: 99%

Barriers to Perinatal Palliative Care Consultation

Benini¹,

Congedi²,

Rusalen³

et al. 2020

Front. Pediatr.

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“…Patients and families may have similar misconceptions about palliative care, perceiving it as a distinct phase in their child's treatment implemented when curative options have been exhausted 7,24,25 . Additionally, despite a recent study showing that the oncology providers’ understanding of the role of PPC is expanding from end‐of‐life care only to the more holistic WHO definition of palliative care, and a recent study showing that most families were open to integrating PPC early in the course of cancer treatment, pediatric oncology providers may not involve a PPC team as they perceive overlap between services provided by both teams 21,26–28 …”

Section: Introductionmentioning

confidence: 99%

“…7,24,25 Additionally, despite a recent study showing that the oncology providers' understanding of the role of PPC is expanding from end-of-life care only to the more holistic WHO definition of palliative care, and a recent study showing that most families were open to integrating PPC early in the course of cancer treatment, pediatric oncology providers may not involve a PPC team as they perceive overlap between services provided by both teams. 21,[26][27][28] At our institution, no formal guidelines or policies existed within the oncology department with regard to PPC involvement. The decision to involve PPC was made at the discretion of primary oncology teams where some patients, even those with poor prognoses, never received PPC involvement.…”

mentioning

confidence: 99%

A quality improvement project to increase palliative care team involvement in pediatric oncology patients

Farooki

Olaiya

Tarbell

et al. 2020

Pediatric Blood & Cancer

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Background: Pediatric palliative care (PPC) for oncology patients improves quality of life and the likelihood of goal-concordant care. However, barriers to involvement exist. Objectives: We aimed to increase days between PPC consult and death for patients with refractory cancer from a baseline median of 13.5 days to ≥30 days between March 2019 and March 2020. Methods: Outcome measure was days from PPC consult to death; process measure was days from diagnosis to PPC consult. The project team surveyed oncologists to identify barriers. Plan-do-study-act cycles included establishing target diagnoses, offering education, standardizing documentation, and sending reminders. Results: The 24-month baseline period included 30 patients who died and 25 newly diagnosed patients. The yearlong intervention period included six patients who died and 16 newly diagnosed patients. Interventions improved outcome and process measures. Targeted patients receiving PPC ≥30 days prior to death increased from 43% to 100%; median days from consult to death increased from 13.5 to 159.5. Targeted patients receiving PPC within 30 days of diagnosis increased from 28% to 63%; median days from diagnosis to consult decreased from 221.5 to 14. Of those without PPC consult ≤ 30 days after diagnosis, 17% had template documentation of the rationale. Conclusion: Interventions utilized met the global aim, outcome, and process measures. Use of QI methodology empowered providers to involve PPC. Poor template use was a barrier to identifying further drivers. Future directions for this project relate to expanding the target list, creating long-term sustainability, formalizing standards, and surveying patients and families.

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“…7,24,25 Additionally, despite a recent study showing that the oncology providers' understanding of the role of PPC is expanding from endof-life care only to the more holistic WHO definition of palliative care, and a recent study showing that most families were open to integrating PPC early in the course of cancer treatment, pediatric oncology providers may not involve a PPC team as they perceive overlap between services provided by both teams. 21,[26][27][28] At our institution, no formal guidelines or policies existed within the oncology department with regards to PPC involvement. The decision to involve PPC was made at the discretion of primary oncology teams where some patients, even those with poor prognoses, never received PPC involvement.…”

Section: Introductionmentioning

confidence: 99%

A quality improvement project to increase palliative care team involvement in pediatric oncology patients

Farooki

Olaiya

Tarbell

et al. 2020

Preprint

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Background: Pediatric palliative care (PPC) for oncology patients improves quality of life and the likelihood of goal-concordant care. However, barriers to involvement exist. Objectives: We aimed to increase days between PPC consult and death for patients with refractory cancer from a baseline median of 13.5 days to [?]30 days between March 2019 and March 2020. Methods: Outcome measure was days from PPC consult to death; process measure was days from diagnosis to PPC consult. The project team surveyed oncologists to identify barriers. Plan-Do-Study-Act cycles included establishing target diagnoses, offering education, standardizing documentation, and sending reminders. Results: The 24-month baseline period included 30 patients that died and 25 newly diagnosed patients. The yearlong intervention period included 6 patients that died and 16 newly diagnosed patients. Interventions improved outcome and process measures. Targeted patients receiving PPC [?] 30 days prior to death increased from 43% to 100%; median days from consult to death increased from 13.5 to 159.5. Targeted patients receiving PPC within 30 days of diagnosis increased from 28% to 63%; median days from diagnosis to consult decreased from 221.5 to 14. Of those without PPC consult within 30 days after diagnosis, 17% had template documentation of the rationale. Conclusion: Interventions utilized met the global aim, outcome and process measures. Use of QI methodology empowered providers to involve PPC. Poor template use was a barrier to identifying further drivers. Future directions for this project relate to expanding the target list, creating long-term sustainability, formalizing standards, and surveying patients and families.

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Defining the Boundaries of Palliative Care in Pediatric Oncology

Cited by 30 publications

References 35 publications

Barriers to Perinatal Palliative Care Consultation

Barriers to Perinatal Palliative Care Consultation

A quality improvement project to increase palliative care team involvement in pediatric oncology patients

A quality improvement project to increase palliative care team involvement in pediatric oncology patients

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