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Hodge CH, Kerris EWJ, Freeman MC, Eckman ST, Deeter DM, Even KM. Implementation of an Innovative Palliative Care Screening Tool in the Pediatric Intensive Care Unit: A Pilot Study. J Palliat Med 2024; 27:307-315. [PMID: 37815840 DOI: 10.1089/jpm.2023.0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
Background: Pediatric palliative care (PPC) can improve the quality of care provided to critically ill children with a high risk of morbidity and mortality. Early identification of patients admitted to the pediatric intensive care unit (PICU) who may benefit from PPC involvement is essential. Objectives: To create a brief screening tool, the Pediatric Intensive Care-Pediatric Palliative Care Screen, identifying PICU patients most likely to benefit from PPC involvement and to assess if weekly screening with this screening tool increases the number of PPC consults placed in the PICU. Methods: This is a prospective investigational single-center study in a 24-bed PICU at a U.S. tertiary care children's hospital. Weekly screening was completed by two clinicians for a six-month period between April and October 2022. Results: A total of 162 screens were completed on 124 individual patients; 47 screens were positive (29%), and 115 were negative (71%). Fourteen new PPC consults were placed from the PICU with one PPC consult for every 36.7 compared with one PPC for every 41.4 admissions the previous year. Of the positive screens, 68% had two or more comorbidities at the time of PICU admission versus 26% of negative screens (p < 0.001). Technology dependence (57% vs. 5%, p < 0.001) and presence of congenital defects (26% vs. 10%, p = 0.013) were significantly more common among positive screens. Conclusions: Weekly screening with a short, 7-question screening tool can identify PICU patients most likely to benefit from a PPC consult. Patients with chronic illnesses and baseline comorbidities are most likely to screen positive.
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Affiliation(s)
- Caitlyn H Hodge
- Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA
| | - Elizabeth W J Kerris
- Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA
| | - Michelle C Freeman
- Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA
| | - Susannah T Eckman
- Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA
| | - Deana M Deeter
- Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA
| | - Katelyn M Even
- Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA
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2
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Iten R, O'Connor M, Gill FJ. Palliative care for infants with life-limiting conditions: integrative review. BMJ Support Palliat Care 2023:spcare-2023-004435. [PMID: 38123923 DOI: 10.1136/spcare-2023-004435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Infants with life-limiting conditions are a heterogeneous population. Palliative care for infants is delivered in a diverse range of healthcare settings and by interdisciplinary primary healthcare teams, which may not involve specialist palliative care service consultation. OBJECTIVE To synthesise the literature for how palliative care is delivered for infants aged less than 12 months with life-limiting conditions. METHODS An integrative review design. MEDLINE, CINAHL, ProQuest, Cochrane, Joanna Briggs Institute and EMBASE were searched for research published in English language, from 2010 to 2022, and peer reviewed. Critical appraisal was completed for 26 patient case series, 9 qualitative, 5 cross-sectional and 1 quality improvement study. Data analysis involved deductive content analysis and narrative approach to summarise the synthesised results. RESULTS 37 articles met the eligibility for inclusion. Two models of palliative care delivery were examined, demonstrating differences in care received and experiences of families and health professionals. Health professionals reported lack of palliative care education, challenges for delivering palliative care in intensive care settings and barriers to advance care planning including prognostic uncertainty and transitioning to end-of-life care. Families reported positive experiences with specialist palliative care services and challenges engaging in advance care planning discussions. CONCLUSION There are complex issues surrounding the provision of palliative care for infants. Optimal palliative care should encompass a collaborative and coordinated approach between the primary healthcare teams and specialist palliative care services and prioritisation of palliative care education for nurses and physicians involved in providing palliative care to infants.
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Affiliation(s)
- Rebecca Iten
- Curtin University, Perth, Western Australia, Australia
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | | | - Fenella J Gill
- Curtin University, Perth, Western Australia, Australia
- Perth Children's Hospital, Nedlands, Western Australia, Australia
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3
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Lotstein D, Klein MJ, Lindley LC, Wolfe J. From Hospital to Home: Referrals to Pediatric Hospice and Home-based Palliative Care. J Pain Symptom Manage 2023; 65:570-579. [PMID: 36828291 DOI: 10.1016/j.jpainsymman.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Abstract
CONTEXT Hospital-based pediatric palliative care (PPC) may help optimize referrals to community-based hospice and home-based palliative care (HBPC) for children with serious illness, yet little is known about their referral practices. OBJECTIVES To describe community-based program referrals from a PPC team, identifying factors associated with referral type, and potential misalignment between patient needs and referral received. METHODS Chart abstraction of patients seen in 2017 by the PPC team of a large, urban children's hospital, followed for at least 6 months or until death, including clinical and demographic characteristics, and referrals to hospice and HBPC. RESULTS Of the 302 study-eligible patients, 25% died during the hospitalization of the first 2017 visit. Of the remaining 228 patients, 42 (18.4%) were referred to HBPC and 58 (25.4%) to hospice. Excluding patients referred to hospice care, only one-third with demographic eligibility were referred to HBPC; those seen in the ICU were least likely to be referred. Over half of the 58 patients referred to hospice died within the study period (n = 34, 58.6%); descendants were more likely to have cancer (P = 0.002) and less likely to have a neurologic (P = 0.021) diagnosis. CONCLUSION Despite demographic eligibility, a minority of patients seen by a hospital-based PPC team received referrals for hospice or HBPC. Children discharged from an ICU and those with neurologic conditions may be at higher risk of missing referrals best aligned with their needs. Future research should identify and address causes of referral misalignment. Advocacy for programs adaptable to patients' changing needs may also be needed.
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Affiliation(s)
- Debra Lotstein
- Division of Comfort and Palliative Care, Department of Anesthesia Critical Care Medicine (D.L.), Children's Hospital Los Angeles, Los Angeles, CA, USA and Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
| | - Margaret J Klein
- Department of Anesthesia Critical Care Medicine (M.J.K.), Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Lisa C Lindley
- College of Nursing, University of Tennessee (L.C.L.), Knoxville, Tennessee, USA
| | - Joanne Wolfe
- Department of Pediatrics (J.W.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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4
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Iten R, O'Connor M, Cuddeford L, Gill FJ. Care management trajectories of infants with life-limiting conditions who died before 12 months of age; a retrospective patient health record review. J Pediatr Nurs 2022; 70:e22-e31. [PMID: 36463014 DOI: 10.1016/j.pedn.2022.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 10/11/2022] [Accepted: 11/11/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE To characterise the care management trajectories of infants with life-limiting conditions, who died before 12 months, including clinical decision-making processes, identification of triggers that led to changes in care management from cure-orientated to palliative care and specialist palliative care team involvement. DESIGN AND METHODS Retrospective patient health record review of infants with life-limiting conditions who died before 12 months of age and received care at three hospitals in Western Australia. Two data analysis methods; directed content analysis and process mapping. RESULTS A total of 45 patient health records were reviewed. Process mapping led to typology of care management encompassing four trajectories; early de-escalation due to catastrophic event; treatment with curative intent throughout; treatment with curative intent until a significant point; and early treatment limits. Standardised advance care planning processes were used for just over 10% of infants. There was specialist palliative care team involvement for 25% of infants. CONCLUSION Only a proportion of infants received early integration of palliative care principles and practices. Infants and their families may benefit from earlier integration of palliative care, and standardised processes for advance care planning that are done in parallel to treatment. PRACTICE IMPLICATIONS There is opportunity to further enhance the delivery of palliative care to infants with life-limiting conditions and optimise the experience for families through education for health professionals, implementation of advance care planning and standardisation through policies and clinical practice guidelines.
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Affiliation(s)
- Rebecca Iten
- School of Nursing, Faculty Health Sciences, Curtin University, Perth 6102, WA, Australia; Perth Children's Hospital, Child and Adolescent Health Service, 15 Hospital Avenue, Nedlands 6009, WA, Australia.
| | - Moira O'Connor
- School of Population Health, Faculty Health Science, Curtin University, Perth 6102, WA, Australia.
| | - Lisa Cuddeford
- Perth Children's Hospital, Child and Adolescent Health Service, 15 Hospital Avenue, Nedlands 6009, WA, Australia.
| | - Fenella J Gill
- School of Nursing, Faculty Health Sciences, Curtin University, Perth 6102, WA, Australia; Perth Children's Hospital, Child and Adolescent Health Service, 15 Hospital Avenue, Nedlands 6009, WA, Australia; Enable Institute, Curtin University, Perth 6102, WA, Australia.
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5
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Linebarger JS, Johnson V, Boss RD, Linebarger JS, Collura CA, Humphrey LM, Miller EG, Williams CSP, Rholl E, Ajayi T, Lord B, McCarty CL. Guidance for Pediatric End-of-Life Care. Pediatrics 2022; 149:186860. [PMID: 35490287 DOI: 10.1542/peds.2022-057011] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The final hours, days, and weeks in the life of a child or adolescent with serious illness are stressful for families, pediatricians, and other pediatric caregivers. This clinical report reviews essential elements of pediatric care for these patients and their families, establishing end-of-life care goals, anticipatory counseling about the dying process (expected signs or symptoms, code status, desired location of death), and engagement with palliative and hospice resources. This report also outlines postmortem tasks for the pediatric team, including staff debriefing and bereavement.
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Affiliation(s)
- Jennifer S Linebarger
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City, School of Medicine, Kansas City, Missouri
| | - Victoria Johnson
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Renee D Boss
- Department of Pediatrics, Johns Hopkins University School of Medicine, Berman Institute of Bioethics, Baltimore, Maryland
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6
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Zuniga-Villanueva G, Widger K, Medeiros C, Trenholm M, Streuli JC. Specialized Pediatric Palliative Care in Neonates with Life-Limiting Illness: A Systematic Review. Am J Perinatol 2021; 38:e318-e329. [PMID: 32330969 DOI: 10.1055/s-0040-1710031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study is to assess the impact of specialized pediatric palliative care (PPC) on neonates with life-limiting conditions compared to standard care. STUDY DESIGN MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, Scopus, and Embase databases were searched from January 2000 to September 2018. Randomized clinical trials, experimental or observational studies, and secondary administrative database analyses published in English, Spanish, French, and German were included. Two independent reviewers extracted data, and used the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool for quality analysis. Discrepancies were resolved as a team. RESULTS From the 37,788 records obtained, only eight articles met the inclusion criteria. A meta-analysis was not possible due to the heterogeneity in how the outcomes were defined; however, a qualitative synthesis of the results was possible; organizing outcomes into eight different categories: psychological, social and spiritual support; communication; location of care; symptom management; bereavement care; predicted versus actual neonatal outcomes; and parental coping, stress, and satisfaction. CONCLUSION Specialized versus may have an impact on neonates with life-limiting conditions and their families. More studies that evaluate the impact of specialized versus in neonates with sound statistical analysis is warranted.
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Affiliation(s)
| | - Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Pediatric Advanced Care Team, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christina Medeiros
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Madeline Trenholm
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Jürg C Streuli
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, University Children's Hospital Zurich, Zurich, Switzerland
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7
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Kaye EC, Weaver MS, DeWitt LH, Byers E, Stevens SE, Lukowski J, Shih B, Zalud K, Applegarth J, Wong HN, Baker JN, Ullrich CK. The Impact of Specialty Palliative Care in Pediatric Oncology: A Systematic Review. J Pain Symptom Manage 2021; 61:1060-1079.e2. [PMID: 33348034 PMCID: PMC9896574 DOI: 10.1016/j.jpainsymman.2020.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Children with cancer and their families have complex needs related to symptoms, decision-making, care planning, and psychosocial impact extending across the illness trajectory, which for some includes end of life. Whether specialty pediatric palliative care (SPPC) is associated with improved outcomes for children with cancer and their families is unknown. OBJECTIVE We conducted a systematic review following PRISMA guidelines to investigate outcomes associated with SPPC in pediatric oncology with a focus on intervention delivery, collaboration, and alignment with National Quality Forum domains. METHODS We searched PubMed, Embase, Scopus, Web of Science, and CINAHL databases from inception until April 2020 and reviewed references manually. Eligible articles were published in English, involved pediatric patients aged 0-18 years with cancer, and contained original data regarding patient and family illness and end-of-life experiences, including symptom management, communication, decision-making, quality of life, satisfaction, and healthcare utilization. RESULTS We screened 6682 article abstracts and 82 full-text articles; 32 studies met inclusion criteria, representing 15,635 unique children with cancer and 342 parents. Generally, children with cancer who received SPPC had improved symptom burden, pain control, and quality of life with decreased intensive procedures, increased completion of advance care planning and resuscitation status documentation, and fewer end-of-life intensive care stays with higher likelihood of dying at home. Family impact included satisfaction with SPPC and perception of improved communication. CONCLUSION SPPC may improve illness experiences for children with cancer and their families. Multisite studies utilizing comparative effectiveness approaches and validated metrics may support further advancement of the field.
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Affiliation(s)
- Erica C Kaye
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
| | - Meaghann S Weaver
- Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Leila Hamzi DeWitt
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Elizabeth Byers
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sarah E Stevens
- Departments of Psychosocial Oncology and Palliative Care and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joe Lukowski
- The University of Nebraska, Omaha, Nebraska, USA
| | - Brandon Shih
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kristina Zalud
- St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jacob Applegarth
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hong-Nei Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, California, USA
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Christina K Ullrich
- Departments of Psychosocial Oncology and Palliative Care and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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8
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McDermott CL, Engelberg RA, Woo C, Li L, Fedorenko C, Ramsey SD, Curtis JR. Novel Data Linkages to Characterize Palliative and End-Of-Life Care: Challenges and Considerations. J Pain Symptom Manage 2019; 58:851-856. [PMID: 31349037 PMCID: PMC6823151 DOI: 10.1016/j.jpainsymman.2019.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 12/12/2022]
Abstract
CONTEXT Working groups have called for linkages of existing and diverse databases to improve quality measurement in palliative and end-of-life (EOL) care, but limited data are available on the challenges of using different data sources to measure such care. OBJECTIVES To assess concordance of data obtained from different sources in a novel linkage of death certificates, electronic health records (EHRs), cancer registry data, and insurance claims for patients who died with cancer. METHODS We joined a database of Washington State death certificates and EHR to a data repository of commercial health plan enrollment and claims files linked to registry records from Puget Sound Cancer Surveillance System. We assessed care in the last month including hospitalizations, intensive care unit (ICU) admissions, emergency department visits, imaging scans, radiation, and hospice, plus chemotherapy in the last 14 days. We used a Chi-squared test to compare differences between health care in EHR and claims. RESULTS Records of hospitalization, ICU use, and emergency department use were 33%, 15%, and 33% lower in EHR versus claims, respectively. Radiation, hospice, and imaging were 6%, 14%, and 28% lower, respectively, in EHR, but chemotherapy was 4% higher than that in claims. These differences were statistically different for hospice (P < 0.02), hospitalization, ICU, ER, and imaging (all P < 0.01) but not radiation (P = 0.12) or chemotherapy (P = 0.29). CONCLUSION We found substantial variation between EHR and claims for EOL health-care use. Reliance on EHR will miss some health-care use, while claims will not capture the complex clinical details in EHR that can help define the quality of palliative care and EOL health-care utilization.
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Affiliation(s)
- Cara L McDermott
- Cambia Palliative Care Center of Excellence Department of Medicine, University of Washington, Seattle, Washington, USA; Hutchinson Institute for Cancer Outcomes Research Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
| | - Ruth A Engelberg
- Cambia Palliative Care Center of Excellence Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Cossette Woo
- Department of Social Welfare University of Washington, Seattle, Washington, USA
| | - Li Li
- Hutchinson Institute for Cancer Outcomes Research Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Catherine Fedorenko
- Hutchinson Institute for Cancer Outcomes Research Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Scott D Ramsey
- Hutchinson Institute for Cancer Outcomes Research Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence Department of Medicine, University of Washington, Seattle, Washington, USA
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9
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Harmoney K, Mobley EM, Gilbertson-White S, Brogden NK, Benson RJ. Differences in Advance Care Planning and Circumstances of Death for Pediatric Patients Who Do and Do Not Receive Palliative Care Consults: A Single-Center Retrospective Review of All Pediatric Deaths from 2012 to 2016. J Palliat Med 2019; 22:1506-1514. [PMID: 31233350 DOI: 10.1089/jpm.2019.0111] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Growing evidence suggests that pediatric palliative care (PPC) teams influence the care received by children and young adults with chronic, life-limiting illnesses. Little is known about how PPC involvement affects advance care planning (ACP) and circumstances of death in pediatric populations with a wide range of diagnoses. Objective: To determine the relationship between PPC involvement, ACP, and circumstances of death for pediatric patients. Design: A retrospective chart review of 558 pediatric patients who died between January 1, 2012 and December 31, 2016 was conducted. Descriptive statistics were used to characterize the sample. A multivariable logistic regression was used to obtain associations between PPC involvement and ACP. Setting: Large, multidisciplinary tertiary care center in a rural state. Measurements: Data abstracted for each patient included the following: demographic information, diagnosis, location of primary unit, hospice involvement, goals of care (GOC), code status, Physician Orders for Life-Sustaining Treatment (POLST) completion, and location of death. Results: Patients with PPC involvement were more likely to have had ACP addressed before death. After adjusting for covariates in the model, patients with PPC were more likely to have their GOC documented (odds ratio [OR] = 96.93), completion of POLST (OR = 24.06), do-not-resuscitate code status (OR = 7.71), and hospice involvement at the time of death (OR = 11.70) compared with those who did not receive PPC. Conclusions: Pediatric patients are more likely to have ACP addressed if they have PPC involvement. Patients with chronic complex conditions are most likely to receive palliative care.
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Affiliation(s)
- Kathryn Harmoney
- Division of Palliative Medicine, Department of Internal Medicine, University of Rochester Medical Center, Rochester, New York
| | - Erin M Mobley
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa
| | | | - Nicole K Brogden
- Department of Pharmaceutical Sciences and Experimental Therapeutics, University of Iowa College of Pharmacy, Iowa City, Iowa
| | - Rebecca J Benson
- Stead Family Division of General Pediatrics and Adolescent Medicine, Stead Family Department of Pediatrics, University of Iowa Healthcare, Iowa City, Iowa
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10
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Spraker-Perlman HL, Tam RP, Bardsley T, Wilkes J, Farley L, Moore D, Sheetz J, Baker JN. The Impact of Pediatric Palliative Care Involvement in the Care of Critically Ill Patients without Complex Chronic Conditions. J Palliat Med 2019; 22:553-556. [DOI: 10.1089/jpm.2018.0469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Holly L. Spraker-Perlman
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Reena P. Tam
- Division of Inpatient Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Tyler Bardsley
- Division of Epidemiology, University of Utah Study Design and Biostatistics Center, University of Utah School of Medicine, Salt Lake City, Utah
- Pediatric Specialty Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | - Jacob Wilkes
- Pediatric Specialty Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | - Leah Farley
- Department of Pediatrics, Beloit Health Systems, Beloit, Wisconsin
| | - Dominic Moore
- Division of Inpatient Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Joan Sheetz
- Division of Inpatient Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Justin N. Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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11
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Widger K, Medeiros C, Trenholm M, Zuniga-Villanueva G, Streuli JC. Indicators Used to Assess the Impact of Specialized Pediatric Palliative Care: A Scoping Review. J Palliat Med 2018; 22:199-219. [PMID: 30526276 DOI: 10.1089/jpm.2018.0420] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Specialized pediatric palliative care programs aim to improve quality of life and ease distress of patients and their families across the illness trajectory. These programs require further development, which should be based on how they improve outcomes for patients, families, health care professionals, and the health care system. OBJECTIVE To identify and compare definitions of indicators used to assess the impact of specialized pediatric palliative care programs. DESIGN The scoping review protocol was prospectively registered on PROSPERO 2017 (CRD42017074090). DATE SOURCES MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, Scopus, and Embase databases were searched from January 2000 to September 2018. Eligible studies included randomized controlled trials, experimental studies, or observational studies that compared specialized programs with usual care. Studies were excluded if most care recipients were older than 19 years or the article was not available in English, French, German, or Spanish. RESULTS Forty-six studies were included; one was a randomized controlled trial. We identified 82 different indicators grouped into 14 domains. The most common indicators included the following: location of death, length of stay in hospital, and number of hospital admissions. Only 22 indicators were defined identically in at least 2 studies. Only one study included children's perspectives in assessing indicators. CONCLUSIONS Many indicators were used to assess program outcomes with little definition consensus across studies. Development of a set of agreed-upon indicators to assess program impact concurrent with family and patient input is essential to advance research and practice in pediatric palliative care.
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Affiliation(s)
- Kimberley Widger
- 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,2 Pediatric Advanced Care Team, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christina Medeiros
- 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Madeline Trenholm
- 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Jürg C Streuli
- 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,3 Pediatric Ethics and Palliative Care, University Children's Hospital Zurich, Zurich, Switzerland
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