Response to Suffering of the Seriously Ill Child: A History of Palliative Care for Children

Sisk, Bryan A.; Feudtner, Chris; Bluebond-Langner, Myra; Sourkes, Barbara M.; Hinds, Pamela S.; Wolfe, Joanne

doi:10.1542/peds.2019-1741

Cited by 55 publications

(50 citation statements)

References 76 publications

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“…The 21st century has heralded significant advances in the field of pediatric palliative care, 1 beginning with Wolfe's seminal paper describing the prevalence of pain among children dying of cancer 2 . Despite strong recommendations by the American Society of Clinical Oncology and Lancet Oncology for integration of palliative care into standard oncology practice, 3,4 as well as the American Academy of Pediatrics’ endorsement that pediatric palliative care and pediatric hospice care competencies, including pain management, “should be a core part of medical school, residency, fellowship, and continuing education curricula as well as pediatric and subspecialty board certifying examinations,” 5 no published evaluations have assessed these skills among pediatric hematology/oncology (PHO) fellows.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of knowledge and comfort with opioid prescribing among pediatric hematology/oncology fellows

MacDonell-Yilmaz

Murillo

Panicker

et al. 2020

Pediatric Blood & Cancer

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Background Deficits in knowledge and comfort related to pain management have been demonstrated in adult hematology/oncology fellows. No such evaluation has been undertaken in pediatric hematology/oncology (PHO) trainees. Procedure An IRB‐approved survey was administered to PHO fellows throughout the United States (US) to assess comfort with opioid dosing, attitudes related to the use of opioids, and knowledge of basic concepts including weight‐based dosing, incomplete cross‐tolerance, and management of side effects. Results Email addresses were obtained for 132 fellows from 37 programs. Seventy‐eight (59%) fellows participated. No significant difference was demonstrated between training level and comfort with dosing opioids in an opioid‐naive patient, though a smaller proportion of first‐year fellows (65%) reported comfort compared to more senior fellows (85.2% of second‐year fellows, 80.6% of third‐ and fourth‐year fellows). First‐year fellows correctly answered a mean of 5.05 ± 0.43 out of 10 objective knowledge questions; second‐year fellows answered 5.74 ± 0.35 correctly, and third‐ and fourth‐year fellows 5.58 ± 0.30. The majority of respondents chose an appropriate dose of intravenous morphine based on weight (92%), and identified a low‐dose naloxone drip as an appropriate intervention for opioid‐induced pruritis (91%). However, the remainder of the questions had a correct response rate of 15‐68%. Conclusion This study characterizes PHO fellows’ knowledge and comfort with prescribing opioids. Despite high levels of reported comfort, PHO fellows in all levels of training demonstrated knowledge gaps. PHO fellows may benefit from further education in pain management.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of knowledge and comfort with opioid prescribing among pediatric hematology/oncology fellows

MacDonell-Yilmaz

Murillo

Panicker

et al. 2020

Pediatric Blood & Cancer

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“…Therefore, conducting a systematic review is worth considering in the future. Improvement of PPC through research and clinician education can reduce the risks of both symptom undertreatment and OIRD [ 53 , 54 , 55 , 56 ].…”

Section: Discussionmentioning

confidence: 99%

Opioid-Induced Respiratory Depression in Pediatric Palliative Care Patients with Severe Neurological Impairment—A Scoping Literature Review and Case Reports

Mauritz

Hasan

Dreier³

et al. 2020

Children

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Pediatric Palliative Care (PPC) addresses children, adolescents, and young adults with a broad spectrum of underlying diseases. A substantial proportion of these patients have irreversible conditions accompanied by Severe Neurological Impairment (SNI). For the treatment of pain and dyspnea, strong opioids are widely used in PPC. Nonetheless, there is considerable uncertainty regarding the opioid-related side effects in pediatric patients with SNI, particularly concerning Opioid-Induced Respiratory Depression (OIRD). Research on pain and OIRD in pediatric patients with SNI is limited. Using scoping review methodology, we performed a systematic literature search for OIRD in pediatric patients with SNI. Out of n = 521 identified articles, n = 6 studies were included in the review. Most studies examined the effects of short-term intravenous opioid therapy. The incidence of OIRD varied between 0.13% and 4.6%; besides SNI, comorbidities, and polypharmacy were the most relevant risk factors. Additionally, three clinical cases of OIRD in PPC patients receiving oral or transdermal opioids are presented and discussed. The case reports indicate that the risk factors identified in the scoping review also apply to adolescents and young adults with SNI receiving low-dose oral or transdermal opioid therapy. However, the risk of OIRD should never be a barrier to adequate symptom relief. We recommend careful consideration and systematic observation of opioid therapy in this population of patients.

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“…Families often worry that the medical team will stop providing care as the child nears end of life. However, this emotional time is when specialized PPC symptom management and compassionate grief interventions take priority [ 17 ]. For some families, the child is old enough and/or awake enough to experience the anticipatory grief of their own death.…”

Section: Anticipatory Griefmentioning

confidence: 99%

Current Grief Support in Pediatric Palliative Care

et al. 2021

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Grief support changes as more is learned from current grief theory and research. The authors provide a comprehensive overview of current grief support as it relates to Pediatric Palliative Care (PPC). The following aspects of grief are addressed: (1) anticipatory grief: the nondeath losses that occur with a complex and chronic illness, as well as the time leading up to death; (2) grief around the time of death: the intense and sacred experience of companioning with a dying child; (3) grief after death: supporting bereavement and mourning through programing and other methods; (4) innovative approaches: the future of grief support. The contents of this article are meant to support and educate programs currently providing grief services and those aiming to begin the meaningful work of grief support.

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Response to Suffering of the Seriously Ill Child: A History of Palliative Care for Children

Cited by 55 publications

References 76 publications

Evaluation of knowledge and comfort with opioid prescribing among pediatric hematology/oncology fellows

Evaluation of knowledge and comfort with opioid prescribing among pediatric hematology/oncology fellows

Opioid-Induced Respiratory Depression in Pediatric Palliative Care Patients with Severe Neurological Impairment—A Scoping Literature Review and Case Reports

Current Grief Support in Pediatric Palliative Care

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