Pediatric Deaths Attributed to Complex Chronic Conditions over 10 Years in Korea: Evidence for the Need to Provide Pediatric Palliative Care

Kim, Min Sun; Lim, Nam Gu; Kim, Hyun Joo; Kim, Chohee; Lee, Jin Yong

doi:10.3346/jkms.2018.33.e1

Cited by 42 publications

(13 citation statements)

References 25 publications

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“…In the present study, the hemato-oncologic disease was the most common diagnosis in children with mortality. This result is similar to a recent study by Kim et al, 23 demonstrating that malignancy was the most common cause of death in children with complex chronic conditions in Korea. Disease severity might be related to the amount of medication used, including off-label medicine use.…”

Section: Discussionsupporting

confidence: 92%

Safety and Efficacy of Off-label and Unlicensed Medicines in Children

et al. 2018

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BackgroundThe aim of this study was to explore the use of off-label/unlicensed drugs to confirm the safety and efficacy of their prescription in children in Korea.MethodsIn this retrospective study, we analyzed data of patients who received any of the 32 drugs between January–December 2014 in tertiary hospitals in Korea, including demographics, diagnoses, reasons for the medication, administration route, and details of adverse drug reactions. Additionally, the mortality in the cohort was assessed. The primary outcomes were efficacy and safety, including mortality, of these drugs in pediatric patients. The secondary outcomes were the current statuses of the use of off-label/unlicensed drugs in two centers.ResultsTotally, 5,130 prescriptions were found in 2,779 patients. Age (73.5%) and indication (11.7%) were the most frequent reasons for prescriptions being off-labeled/unlicensed. Approximately 88% of the prescriptions were effective, and 19% of the patients developed adverse drug reactions. The number of prescriptions was significantly higher in children with adverse drug reactions than it was in those without (2.8 vs. 1.5; P < 0.001). The number of prescribed off-label/unlicensed medicines and age at prescription were independently associated with adverse drug events (odds ratio, 1.55 and 1.1; P < 0.001 and 0.034, respectively).ConclusionChildren are still prescribed medicines that are not authorized in terms of age, weight, indications, or routes of administration. Therefore, many old products require re-assessment of authorization. More prospective clinical studies should be performed to confirm the efficacy and safety of drugs in the pediatric population.

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Section: Discussionsupporting

confidence: 92%

Safety and Efficacy of Off-label and Unlicensed Medicines in Children

et al. 2018

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“…Despite the dazzling development of modern medicine, over 1,000 children with complex chronic conditions die in Korea every year. 30 The large perception discrepancy between physicians and non-physicians suggests that conflict may arise in communication about end-of-life care for children. Clinicians should be trained to identify families' worries and facilitate open communication while respecting that every family has unique needs.…”

Section: Discussionmentioning

confidence: 99%

Discordance between Physician and the General Public Perceptions of Prognostic Disclosure to Children with Serious Illness: a Korean Nationwide Study

et al. 2018

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BackgroundIt is difficult to decide whether to inform the child of the incurable illness. We investigated attitudes of the general population and physicians toward prognosis disclosure to children and associated factors in Korea.MethodsPhysicians working in one of 13 university hospitals or the National Cancer Center and members of the general public responded to the questionnaire. The questionnaire consisted of the age appropriate for informing children about the prognosis and the reason why children should not be informed. This survey was conducted as part of research to identify perceptions of physicians and general public on the end-of-life care in Korea.ResultsA total of 928 physicians and 1,241 members of the general public in Korea completed the questionnaire. Whereas 92.7% of physicians said that children should be informed of their incurable illness, only 50.7% of the general population agreed. Physicians were also more likely to think that younger children should know about their poor prognosis compared with the general population. Physicians who opposed incurable illness disclosure suggested that children might not understand the situation, whereas the general public was primarily concerned that disclosure would exacerbate the disease. Physicians who were women or religious were more likely to want to inform children of their poor prognosis. In the general population, gender, education, comorbidity, and caregiver experience were related to attitude toward poor prognosis disclosure to children.ConclusionOur findings indicate that physicians and the general public in Korea differ in their perceptions about informing children of poor prognosis.

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“…1 In South Korea, 2900-3600 children <19 years die annually, of which 1000-1200 die from complex chronic conditions. 2 In South Korea, hospice care, which began in 1965 and lasted until recently, was limited to terminal cancer inpatients who relinquished cure-directed care. Since the enactment of relevant laws and regulations in 2017, the subjects of palliative care have been expanded to include patients with AIDS, liver cirrhosis, or chronic obstructive pulmonary diseases; moreover, patients with refractory cancer and expenditures have increased.…”

Section: Introductionmentioning

confidence: 99%

Perceptions of Pediatric Palliative Care among Physicians Who Care for Pediatric Patients in South Korea

Song

Kim

et al. 2020

Journal of Palliative Medicine

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Background: Despite advances in medical technology, resources for pediatric palliative care (PPC) for children with serious illnesses are limited in South Korea. Physicians' awareness of and willingness to provide general palliative care and refer to specialized palliative care are key elements for providing PPC. Objective: The aim of this study was to explore physicians' perceptions of PPC and the differences therein between nononcologists and oncologists. Design: A nationwide survey was conducted among physicians caring for children in 45 tertiary hospitals in South Korea. Measurements: A questionnaire was developed to identify the confidence in and need for PPC, appropriate timing for PPC referrals, and perceived barriers to PPC. Results: Overall, 141 physicians responded (response rate: 10.4%). Physicians' confidence in PPC was low, although most reported a high need for PPC. Lack of workforce and facilities specialized in PPC (60.2%) and patients' or caregivers' negative recognition (55.9%) were reported as the main barriers to PPC implementation. Specialized PPC services in children's hospitals were preferred as the model of care (84.2%). Compared with nononcologists, oncologists showed higher confidence levels in decision making and communication with patients and families with poor prognosis (p = 0.041) and education and providing end-of-life care (p < 0.001). Furthermore, oncologists preferred earlier referrals than did nononcologists. Conclusions: To promote PPC provision and improve the quality of life of pediatric patients and their families, it is important to introduce PPC early into disease-modifying treatment at any level of health care. Developing education and training curricula regarding PPC for health care providers caring for children with severe illnesses is crucial.

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Pediatric Deaths Attributed to Complex Chronic Conditions over 10 Years in Korea: Evidence for the Need to Provide Pediatric Palliative Care

Cited by 42 publications

References 25 publications

Safety and Efficacy of Off-label and Unlicensed Medicines in Children

Safety and Efficacy of Off-label and Unlicensed Medicines in Children

Discordance between Physician and the General Public Perceptions of Prognostic Disclosure to Children with Serious Illness: a Korean Nationwide Study

Perceptions of Pediatric Palliative Care among Physicians Who Care for Pediatric Patients in South Korea

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