Initiating Palliative Care Referrals in Pediatric Oncology

Triggers for Palliative Care Referral in Pediatric Oncology

“…Previous literature highlights the predominant opinion that PC is consulted “too late” in the realm of pediatric oncology [ 6 , 15 , 22 , 23 ] and our group has previously shown that 84% of interdisciplinary pediatric oncology providers thought that a screening tool could help overcome this problem and increase early PC involvement. Providers in that study identified specific “high yield” trigger criteria for a screening tool, including poor prognosis, symptom management needs, comorbidities and psychosocial needs [ 15 ]. Additional literature-based triggers for early PC integration include the need for BMT, no therapeutic options remaining and disease progression [ 16 , 17 , 24 ].…”

“…Additionally, as medicine continues to make advances in the treatment of childhood cancer, prognostication becomes more uncertain, and may contribute to late PC referrals [ 23 , 28 , 29 , 30 , 31 , 32 ]. In one of our earlier studies, we found that providers were able to theorize ideal triggers for PC referral better than they were able to identify them in a clinical case scenario [ 15 ]. For example, comorbidities in our study were not found to increase the likelihood of PC consultation yet were previously cited by oncologists as a potential trigger for PC [ 15 ].…”

“…In one of our earlier studies, we found that providers were able to theorize ideal triggers for PC referral better than they were able to identify them in a clinical case scenario [ 15 ]. For example, comorbidities in our study were not found to increase the likelihood of PC consultation yet were previously cited by oncologists as a potential trigger for PC [ 15 ]. This is particularly important as the disease paradigm for cancer treatment shifts from a cure-based model to a chronic illness model thereby increasing the likelihood for the presence of comorbidities in this patient population as a result of disease or therapy related complications.…”

“…Commonly, reported barriers to PC involvement revolve around lack of communication and resources, increased need for education, and systems-based issues [ 5 , 10 , 15 , 30 ]. Our study offers the foundation for a potential solution to assist with systems-based barriers, specifically, the standardization of referral practices to PC through a screening tool.…”

“…And given the limitation of PC resources in many hospitals across the country [ 14 ], it is important for the early identification of patients to allow for time for PC subspecialists to develop relationships and meaningfully contribute to goals of care. In a recent semi-structured interview study pediatric oncology provider identified patient triggers for early PC referral and endorsed the development of a standardized screening tool with these triggers to facilitate earlier PC involvement [ 15 ]. This study aimed to determine how often patients at a major cancer center had the documented triggers for PC consultation, and among them, how many then received a PC consult.…”