PPC teams currently serve a diverse cohort of children and young adults with life-threatening conditions. In contrast to the reported experience of adult-oriented palliative care teams, most PPC patients are alive for more than a year after initiating PPC.

BACKGROUND: Pediatric palliative care (PPC) programs facilitate the provision of comprehensive care to seriously ill children. Over the past 10 years many such programs have been initiated by children’s hospitals, but little is known about their number, staff composition, services offered, sources of support, or national distribution. METHODS: In the summer of 2012, we surveyed 226 hospitals as identified by the National Association of Children’s Hospitals and Related Institutions. The survey instrument gathered data about whether their institution had a PPC program, and for hospitals with programs, it asked for a wide range of information including staffing, patient age range, services provided, and financial support. RESULTS: Of the 162 hospitals that provided data (71.7% response rate), 69% reported having a PPC program. The rate of new program creation peaked in 2008, with 12 new programs created that year, and 10 new programs in 2011. Most programs offer only inpatient services, and most only during the work week. The number of consults per year varied substantially across programs, and was positively associated with hospital bed size and number of funded staff members. PPC programs report a high level of dependence on hospital funding. CONCLUSIONS: PPC programs are becoming common in children’s hospitals throughout the United States yet with marked variation in how these programs are staffed, the level of funding for staff effort to provide PPC, and the number of consultations performed annually. Guidelines for PPC team composition, funding, and consultation standards may be warranted to ensure the highest quality of PPC.

AbstrAct:The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidencebased care that improves patient outcomes such as health-related quality of life and is consistent with the patients' values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions. Palliative care, defined as patient-and family-centered care that optimizes health-related quality of life by anticipating, preventing, and treating suffering, should be integrated into the care of all patients with advanced cardiovascular disease and stroke early in the disease trajectory. Palliative care focuses on communication, shared decision making about treatment options, advance care planning, and attention to physical, emotional, spiritual, and psychological distress with inclusion of the patient's family and care system. Our policy recommendations address the following: reimbursement for comprehensive delivery of palliative care services for patients with advanced cardiovascular disease and stroke; strong payerprovider relationships that involve data sharing to identify patients in need of palliative care, identification of better care and payment models, and establishment of quality standards and outcome measurements; healthcare system policies for the provision of comprehensive palliative care services during hospitalization, including goals of care, treatment decisions, needs of family caregivers, and transition to other care settings; and health professional education in palliative care as part of licensure requirements.

Despite increasing data to support pediatric palliative care (PPC) as an integral component of high-quality care for children with life-threatening conditions and their families, timely integration of PPC is offered inconsistently to children with high-risk cancer. In this review, we summarize the growing body of literature in support of early integration of PPC for children with high-risk cancer and their families, advocating that PPC principles and resources are imperative to holistic cancer-directed care and rooted in evidence-based medicine. Finally, we offer possible strategies for optimizing integration of PPC into holistic cancer care for children and families.

Take free quizzes online at acsjournals.com/ce ONLINE CONTINUING EDUCATION ACTIVITYAfter reading the article "Pediatric Palliative Care in the Community" the learner should be able to: 1. Describe the scope of pediatric palliative care and community-based pediatric palliative care. 2. Review the indications for referral of children with cancer to pediatric palliative care and community-based pediatric palliative care. 3. Discuss the benefits of and barriers to referral of children with cancer to pediatric palliative care and community-based pediatric palliative care. ARTICLE TITLE: Pediatric Palliative Care in the Community CONTINUING MEDICAL EDUCATION ACCREDITATION AND DESIGNATION STATEMENT:Blackwell Futura Media Services is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians.Blackwell Futura Media Services designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit™. Physicians s hould only claim credit commensurate with the extent of their participation in the activity. CONTINUING NURSING EDUCATION ACCREDITATION AND DESIGNATION STATEMENT:The American Cancer Society (ACS) is accredited as a provider of continuing nursing education (CNE) by the American Nurses Credentialing Center's Commission on Accreditation.Accredited status does not imply endorsement by the ACS or the American Nurses Credentialing Center of any commercial products displayed or discussed in conjunction with an educational activity. The ACS gratefully acknowledges the sponsorship provided by Wiley for hosting these CNE activities. EDUCATIONAL OBJECTIVES: ACTIVITY DISCLOSURESThis work was supported by the American Lebanese Syrian Associated Charities (ALSAC). ACS CONTINUING PROFESSIONAL EDUCATION COMMITTEE DISCLOSURESEditor, Director of Continuing Professional Education, and ACS Director of Medical Content Ted Gansler, MD, MBA, MPH, has no financial relationships or interests to disclose. Deputy Editor and ACS Director of Prostate and Colorectal CancersDurado Brooks, MD, MPH, has no financial relationships or interests to disclose. Lead Nursing and Associate Editor Marcia Grant, RN, PhD, FAAN, has no financial relationships or interests to disclose. Associate Editor and Chief Cancer Control Officer Richard C. Wender, MD, has no financial relationships or interests to disclose. AUTHOR DISCLOSURESErica C. Kaye, MD, Jared Rubenstein, MD, Deena Levine, MD, Justin N. Baker, MD, Devon Dabbs, BBA, and Sarah E. Friebert, MD have no financial relationships or interests to disclose.CNE CME SCORING A score of 70% or better is needed to pass a quiz containing 10 questions (7 correct answers), or 80% or better for 5 questions (4 correct answers). INSTRUCTIONS ON RECEIVING CME CREDITThis activity is intended for physicians. For information concerning the applicability and acceptance of CME credit for this activity, please consult your professional licensing board.This activity is designed to be completed within 1.5 hours; physicians should claim only those...

Despite the well-established benefit of pediatric palliative care, it is only offered in 58% of COG institutions caring for children with cancer. In an era where the benefit of palliative care has been clearly established, this number should approach 100%. Efforts should be directed toward understanding barriers to provision of such services, so that they are available and well used at all childhood cancer centers.

There is a dearth of studies examining the association between lone parenting and psychosocial functioning among children and adolescents with chronic illnesses. Specific questions necessitating future investigation are summarized and recommendations are made for future research in this important area of inquiry.

Pediatric palliative care and pediatric hospice care (PPC-PHC) are often essential aspects of medical care for patients who have life-threatening conditions or need end-of-life care. PPC-PHC aims to relieve suffering, improve quality of life, facilitate informed decision-making, and assist in care coordination between clinicians and across sites of care. Core commitments of PPC-PHC include being patient centered and family engaged; respecting and partnering with patients and families; pursuing care that is high quality, readily accessible, and equitable; providing care across the age spectrum and life span, integrated into the continuum of care; ensuring that all clinicians can provide basic palliative care and consult PPC-PHC specialists in a timely manner; and improving care through research and quality improvement efforts. PPC-PHC guidelines and recommendations include ensuring that all large health care organizations serving children with life-threatening conditions have dedicated interdisciplinary PPC-PHC teams, which should develop collaborative relationships between hospital-and community-based teams; that PPC-PHC be provided as integrated multimodal care and practiced as a cornerstone of patient safety and quality for patients with life-threatening conditions; that PPC-PHC teams should facilitate clear, compassionate, and forthright discussions about medical issues and the goals of care and support families, siblings, and health care staff; that PPC-PHC be part of all pediatric education and training curricula, be an active area of research and quality improvement, and exemplify the highest ethical standards; and that PPC-PHC services be supported by financial and regulatory arrangements to ensure access to high-quality PPC-PHC by all patients with life-threatening and life-shortening diseases. Pediatrics 2013;132:966-972 INTRODUCTIONOver the past two decades, pediatric palliative care has emerged as an established field of medical expertise and practice. [1][2][3] Recognized in 2006 by the American Board of Medical Specialties, hospice and palliative medicine is the field of medical expertise that seeks to improve quality of life and reduce various forms of distress for patients and their families in the face of serious life-threatening or inevitably lifeshortening conditions or when end-of-life care or bereavement services are needed. Pediatric palliative care addresses the needs of infants, children, adolescents, and young adults (subsequently referred to SECTION collectively as "children") with these conditions and the needs of their families, providing treatments that aim to (1) relieve suffering across multiple realms, including the physical (eg, pain or dyspnea), psychological (depression, anxiety, or sense of guilt), social (isolation), practical (home-based services or financial stress), and existential or spiritual (why is this happening?); (2) improve the child' s quality and enjoyment of life while helping families adapt and function during the illness and through bereavement; (3) f...