Multidisciplinary Clinician Perspectives on Embedded Palliative Care Models in Pediatric Cancer

Salek, Marta; Woods, Cameka; Gattas, Melanie; Gattuso, Jami S.; Mandrell, Belinda N.; Baker, Justin N.; Kaye, Erica C.

doi:10.1016/j.jpainsymman.2022.05.019

Cited by 11 publications

(15 citation statements)

References 31 publications

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“…Therefore, given the significant individualized differences in children with tumors, employing a multidisciplinary team approach may be an important part of addressing these symptoms. 36 Because it considers the specificity of the child, the specificity of the disease, and the actual needs of the child to reduce suffering, promote comfort, and facilitate symptom management in palliative care.…”

Section: Discussionmentioning

confidence: 99%

Existential experiences and perceptions of death among children with terminal cancer: An interpretative qualitative study

Lin

et al. 2023

Palliat Med

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Background: Exploring the experience and understanding of death in children with terminal cancer is important to provide them with appropriate care. However, most studies have focused on the perspectives of parents and healthcare professionals, and few have focused on the end-of-life experiences of children. Aim: To advance the understanding of end-of-life experiences and perceptions of death in children with cancer. Design: Interpretative qualitative study using semi-structured interviews. Data were analyzed using reflexive thematic analysis. Setting/participants: The study was conducted at the department of oncological surgery, Children’s Hospital, Zhejiang University School of Medicine. Ten children aged 8–17 with terminal cancer were included in the study. Results: Four major themes (and eight sub-themes) were identified from the findings: (1) helplessness in the face of death (loneliness, loss of control); (2) desire to connect with the world they left (reluctantly to be forgotten, sense of self-worth); (3) perceptions and attitudes toward death (separating from loved ones, embracing death); (4) expectations of future life (promoting comfort, fulfilling wishes). Conclusions: Children with terminal cancer have a strong sense of loneliness and a desire to connect with the world they have left behind. Differences in children’s perceptions and attitudes about death suggest that healthcare professionals should focus on their experiences and needs and provide personalized palliative care services to children and their families to improve their quality of life.

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Section: Discussionmentioning

confidence: 99%

Existential experiences and perceptions of death among children with terminal cancer: An interpretative qualitative study

Lin

et al. 2023

Palliat Med

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“…57 Though this seems easily acceptable and achievable, its application may be limited by lack of PO staff with PPC expertise. 58 This model could also work for outpatient care, alongside other possible models (e.g., floating clinics and telehealth). 55 In the 'integrated care' model, teams work together from diagnosis, 37 thus enhancing their combined expertise to provide the comprehensive care needed throughout the cancer journeyoncologists will necessarily be more focused on disease-directed care, while palliativists focus on addressing distress and holistic needs.…”

Section: How Can Paediatric Palliative Care Be Delivered To Children ...mentioning

confidence: 99%

“…It leads to a model of 'embedded expertise', where a professional in the PO team with education and training in PPC (doctor or nurse) supports the CYP and family, and links to (but does not replace) the PPC team if one is available 57 . Though this seems easily acceptable and achievable, its application may be limited by lack of PO staff with PPC expertise 58 . This model could also work for outpatient care, alongside other possible models (e.g., floating clinics and telehealth) 55 …”

Section: How Can Paediatric Palliative Care Be Delivered To Children ...mentioning

confidence: 99%

Embracing paediatric palliative care in paediatric oncology from diagnosis onwards

Lacerda

Martínez

Dumont

et al. 2023

Pediatric Blood & Cancer

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Paediatric palliative care aims to support children and young people with life‐limiting or life‐threatening conditions, and their families, from the time of diagnosis. Early integration within oncology has been recognised as having benefits for all involved, whatever the outcome may be. Through improved communication and advance care planning, it enables user‐centred care, where concerns about quality of life, preferences and values are given the same relevance as cutting‐edge therapy. Challenges to the integration of palliative care within paediatric oncology include raising awareness and providing education, whilst searching for the best care model and adapting to an ever‐changing therapeutic scenario.

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“…12 Perceived benefits of embedded PPC among multidisciplinary team members include early integration, routinization of care, and accessibility of PPC. 22 There are several notable gaps in the literature surrounding embedded PPC. First, few studies describe institutional experiences creating embedded models of PPC in pediatric oncology.…”

Section: Introductionmentioning

confidence: 99%

“…Embedded palliative care, defined as a model of care with shared workspace for palliative specialists and oncologists, has emerged as one way to improve access to palliative care in the outpatient oncology setting 12 . Perceived benefits of embedded PPC among multidisciplinary team members include early integration, routinization of care, and accessibility of PPC 22 …”

Section: Introductionmentioning

confidence: 99%

Consultation patterns before and after embedding pediatric palliative care into a pediatric hematology/oncology clinic

Greenmyer,

Ngo,

Smith

et al. 2023

Pediatric Blood & Cancer

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IntroductionPalliative care is a critical component of pediatric oncology care. Embedded pediatric palliative care (PPC) is relatively new in pediatric hematology/oncology (PHO) and may improve access, utilization, and quality of PPC. In June 2020, the Mayo Clinic PPC service transitioned from an afternoon, physically independent clinic to an all‐day clinic embedded within PHO.MethodsRetrospective chart review was used to quantify consultation rates from PHO to PPC in 12‐month study periods before and after establishment of an embedded clinic. Changes in descriptive statistics and consult patterns were calculated. Study periods were compared using either chi‐square or Fisher's exact tests for categorical variables and Wilcox rank sum tests for continuous variables.ResultsThere was an 89% increase in consultations from PHO to PPC after initiation of an embedded clinic (n = 20 vs. n = 38 per 12 months). The absolute number of completed outpatient consults increased from three (15% of visits) pre‐embedment to fourteen (37%) post‐embedment (p = .082). The median number of days from first oncology visit to PPC assessment was unchanged after embedment (36 vs. 47 days, p = .98). Consults for solid tumors increased from 22% (n = 4) pre‐embedment to 60% (n = 18) post‐embedment (p < .05). Consults for symptom management increased from 60% (n = 12) to 87% (n = 33) (p < .05).ConclusionsEmbedment of PPC into a PHO workspace was associated with an increased number of total consults, outpatient consults, solid tumor consults, and consults for symptom management. Our “partial‐PPO” model allowed for provision of PPC in the outpatient oncology setting in a clinic where there is not enough volume to support a full‐time oncology‐focused clinician team.

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Multidisciplinary Clinician Perspectives on Embedded Palliative Care Models in Pediatric Cancer

Cited by 11 publications

References 31 publications

Existential experiences and perceptions of death among children with terminal cancer: An interpretative qualitative study

Existential experiences and perceptions of death among children with terminal cancer: An interpretative qualitative study

Embracing paediatric palliative care in paediatric oncology from diagnosis onwards

Consultation patterns before and after embedding pediatric palliative care into a pediatric hematology/oncology clinic

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