Palliative care consultation in pediatric oncology

Johnston, Donna L.; Vadeboncoeur, Christina

doi:10.1007/s00520-011-1152-6

Cited by 66 publications

(76 citation statements)

References 12 publications

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“…This percent is lower than other contemporary reports. 7,16,17 Although the completeness and accuracy of the billing codes cannot be verified, all hospitals had patients with the PC V-code, so it is unlikely that the low percent of patients is due to lack of coding for services. If the billing codes were missing in some cases, they are likely to be randomly missing, so the trends found should be representative.…”

Section: Resultsmentioning

confidence: 99%

“…18 Previous studies have demonstrated a delay in referral to PC based on the belief that a referral is not needed until curative treatment is no longer the sole goal. 7,19 More recently PC and curative care are being delivered concurrently; however, further investigation is needed to determine when, in the course of illness, children are referred to PC.…”

Section: Resultsmentioning

confidence: 99%

“…[20][21][22] Our study showed that coding for PC increased over the study period, which is consistent with recent studies showing an increase in PC programs over the past 10 years. [4][5][6][7] However, availability of a PC team does not equate to widespread use. Johnston found that in Canada, although 88% of the centers evaluated had PC teams, ,16% of patients received these services at the time of their death.…”

Section: Resultsmentioning

confidence: 99%

“…[4][5][6][7] However, data from the National Hospice and Palliative Care Organization in 2010 showed that of the 1.58 million people who used hospice services, only 0.4% (6320) were aged ,24 years. 8 Feudtner stated that on any given day, ∼5000 children are living within the last 6 months of their lives.…”

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confidence: 99%

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Differences in Characteristics of Dying Children Who Receive and Do Not Receive Palliative Care

Keele¹,

Keenan²,

et al. 2013

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OBJECTIVE: Comparing demographic and clinical characteristics associated with receipt of palliative care (PC) among children who died in children’s hospitals to those who did not receive PC and understanding the trends in PC use. METHODS: This retrospective cohort study used the Pediatric Health Information System database. Children <18 years of age who died ≥5 days after admission to a Pediatric Health Information System hospital between January 1, 2001, and December 31, 2011 were included. Receipt of PC services was identified by the International Classification of Diseases, Ninth Revision code for PC. Diagnoses were grouped using major diagnostic codes. International Classification of Diseases codes and clinical transaction codes were used to evaluate all interventions. RESULTS: This study evaluated 24 342 children. Overall, 4% had coding for PC services. This increased from 1% to 8% over the study years. Increasing age was associated with greater receipt of PC. Children with the PC code had fewer median days in the hospital (17 vs 21), received fewer invasive interventions, and fewer died in the ICU (60% vs 80%). Receipt of PC also varied by major diagnostic codes, with the highest proportion found among children with neurologic disease. CONCLUSIONS: Most pediatric patients who died in a hospital did not have documented receipt of PC. Children receiving PC are different from those who do not in many ways, including receipt of fewer procedures. Receipt of PC has increased over time; however, it remains low, particularly among neonates and those with circulatory diseases.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Differences in Characteristics of Dying Children Who Receive and Do Not Receive Palliative Care

Keele¹,

Keenan²,

et al. 2013

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“…Despite the fact that palliative care is now widely recognized as a critical part of excellent care for children with life-limiting diseases such as cancer, patients continue to receive this care very late in their illness trajectory [12,13]. In 1 study, the median time between palliative care consultation and death was only 8 days [14].…”

Section: Ray Barfieldmentioning

confidence: 94%

Pediatric Oncology and Palliative Care

Barfield

2014

North Carolina Medical Journal

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Overall, we now cure 70% of the children who are diagnosed with cancer, and in the 30% of cases that are still not curable, we can almost always add time to the child's life. As our ability to cure cancer has improved, we are now paying increased attention to the goal of avoiding or alleviating the suffering associated with cancer and its therapy. Risk stratification aims to avoid undertreatment of children with high-risk cancers and to avoid overtreatment (with all of the associated side effects of therapy) of children with lower-risk cancers. This goal has become an important part of designing treatment protocols over the past 15 years.Whether or not a child will be cured, we know that all children with cancer suffer, as do their families. Pediatric oncology is committed to curing cancer, but palliative care is committed to improving a child's quality of life, irrespective of the potential for cure. Oncology and palliative care are thus twin endeavors, both of which seek what is best for a child and his or her family [1]. Within the 2 broad categories of curing disease and alleviating suffering, there are many specific goals unique to each patient. Palliative care seeks to relieve the physical, emotional, social, and spiritual distress produced by complex, chronic, or life-limiting conditions; to assist in making difficult decisions and setting goals; and to enhance children's quality of life [2].More than a decade has passed since the American Academy of Pediatrics [3] and the Institute of Medicine of the National Academies [4] called for the integration of palliative care into ongoing medical management of lifethreatening illnesses (such as cancer) in children, from diagnosis to the end of life. Since these calls were issued, models of integrated pediatric palliative care have been developed in which curative therapy and palliative care coexist. For children whose lives are going to be short, adding a few months of good-quality life can be transformative. Adding 6 months to the life of a child who would otherwise have died at 3.5 years of age is extending his or her life by nearly 15%.

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Palliative care initiation in pediatric oncology patients: A systematic review

et al. 2018

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Palliative care (PC) aims to improve quality of life for patients and their families. The World Health Organization and American Academy of Pediatrics recommend that PC starts at diagnosis for children with cancer. This systematic review describes studies that reported PC timing in the pediatric oncology population. The following databases were searched: PubMed, Web of Science, CINAHL, and PsycInfo databases. Studies that reported time of PC initiation were independently screened and reviewed by 2 researchers. Studies describing pilot initiatives, published prior to 1998, not written in English, or providing no empirical time information on PC were excluded. Extracted data included sample characteristics and timing of PC discussion and initiation. Of 1120 identified citations, 16 articles met the inclusion criteria and comprised the study cohort. Overall, 54.5% of pediatric oncology patients received any palliative service prior to death. Data revealed PC discussion does not occur until late in the illness trajectory, and PC does not begin until close to time of death. Despite efforts to spur earlier initiation, many pediatric oncology patients do not receive any palliative care service, and those who do, predominantly receive it near the time of death. Delays occur both at first PC discussion and at PC initiation. Efforts for early PC integration must recognize the complex determinants of PC utilization across the illness timeline.

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Palliative care consultation in pediatric oncology

Abstract: The majority of children in this study who died from cancer were referred to palliative care. Oncologists should strive to refer patients early in their disease.

Cited by 66 publications

References 12 publications

Differences in Characteristics of Dying Children Who Receive and Do Not Receive Palliative Care

Differences in Characteristics of Dying Children Who Receive and Do Not Receive Palliative Care

Pediatric Oncology and Palliative Care

Palliative care initiation in pediatric oncology patients: A systematic review

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